Healthcare Provider Details

I. General information

NPI: 1669077707
Provider Name (Legal Business Name): OXFORD ANESTHESIA MANAGEMENT, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/04/2020
Last Update Date: 05/04/2021
Certification Date: 05/04/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

MID-COLUMBIA MEDICAL CENTER 1700 E 19TH STREET
THE DALLES OR
97058-3317
US

IV. Provider business mailing address

PO BOX 69355
BALTIMORE MD
21264-9355
US

V. Phone/Fax

Practice location:
  • Phone: 541-296-7760
  • Fax:
Mailing address:
  • Phone: 833-352-0096
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License Number
License Number State

VIII. Authorized Official

Name: ALEX GORECKI
Title or Position: CHIEF OPERATING OFFICER
Credential:
Phone: 850-497-6702