Healthcare Provider Details

I. General information

NPI: 1023338290
Provider Name (Legal Business Name): OASIS PHYSICAL MEDICINE,LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/10/2010
Last Update Date: 12/09/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4010 NORTH MAIN STREET SUITE 2
COLUMBIA SC
29203-5848
US

IV. Provider business mailing address

4010 NORTH MAIN STREET
COLUMBIA SC
29203-5848
US

V. Phone/Fax

Practice location:
  • Phone: 803-786-2300
  • Fax: 803-786-1307
Mailing address:
  • Phone: 803-786-2300
  • Fax: 803-786-1307

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number1043
License Number StateSC
# 2
Primary TaxonomyN
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number2604
License Number StateSC
# 3
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number
License Number State
# 5
Primary TaxonomyN
Taxonomy Code225700000X
TaxonomyMassage Therapist
License Number
License Number State
# 6
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number
License Number State
# 7
Primary TaxonomyY
Taxonomy Code208100000X
TaxonomyPhysical Medicine & Rehabilitation Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. BEATRICE GAMBLE
Title or Position: PRESIDENT
Credential: D.C.
Phone: 803-786-2300