Healthcare Provider Details

I. General information

NPI: 1881438992
Provider Name (Legal Business Name): OXFORD OUTPATIENT CENTER, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/24/2024
Last Update Date: 06/24/2024
Certification Date: 06/23/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1150 CHURCH RD W
SOUTHAVEN MS
38671-7144
US

IV. Provider business mailing address

1150 CHURCH RD W
SOUTHAVEN MS
38671-7144
US

V. Phone/Fax

Practice location:
  • Phone: 662-205-0455
  • Fax:
Mailing address:
  • Phone: 662-205-0455
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code324500000X
TaxonomySubstance Abuse Rehabilitation Facility
License Number
License Number State

VIII. Authorized Official

Name: MS. KEISHA WYNN
Title or Position: DIRECTOR OF OUTPATIENT OPERATIONS
Credential: BSN, RN
Phone: 828-215-1455