Healthcare Provider Details

I. General information

NPI: 1194101352
Provider Name (Legal Business Name): OXFORD TREATMENT CENTER, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/10/2015
Last Update Date: 08/25/2021
Certification Date: 08/25/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

341 E MAIN ST
TUPELO MS
38804-4025
US

IV. Provider business mailing address

200 POWELL PL ATTN: LEGAL DEPARTMENT
BRENTWOOD TN
37027-7514
US

V. Phone/Fax

Practice location:
  • Phone: 662-680-2636
  • Fax: 615-457-8094
Mailing address:
  • Phone: 615-732-1605
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QR0405X
TaxonomySubstance Use Disorder Rehabilitation Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: MARK STOVALL
Title or Position: FACILITY CEO
Credential:
Phone: 662-281-9992