Healthcare Provider Details

I. General information

NPI: 1073973541
Provider Name (Legal Business Name): OXFORD COLLEGE CORNER CLINIC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/26/2016
Last Update Date: 02/26/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5151 MORNING SUN RD
OXFORD OH
45056-9545
US

IV. Provider business mailing address

PO BOX 390
OXFORD OH
45056-0390
US

V. Phone/Fax

Practice location:
  • Phone: 513-524-5426
  • Fax: 513-524-5482
Mailing address:
  • Phone: 513-524-5426
  • Fax: 513-524-5482

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251V00000X
TaxonomyVoluntary or Charitable Agency
License Number261Q00000X
License Number StateOH

VIII. Authorized Official

Name: MARILYN J SASSER
Title or Position: EXECUTIVE DIRECTOR
Credential:
Phone: 513-524-5426