Healthcare Provider Details

I. General information

NPI: 1134106693
Provider Name (Legal Business Name): OAKTREE MEDICAL CENTRE, PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/27/2005
Last Update Date: 10/30/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

200 PATEWOOD DR SUITE A 350
GREENVILLE SC
29615-3593
US

IV. Provider business mailing address

PO BOX 484
EASLEY SC
29641-0484
US

V. Phone/Fax

Practice location:
  • Phone: 864-242-6447
  • Fax: 864-242-6517
Mailing address:
  • Phone: 864-855-1633
  • Fax: 864-855-1323

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QP3300X
TaxonomyPain Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: DR. DANIEL A. MCCOLLUM
Title or Position: PRESIDENT
Credential: D.C.
Phone: 864-855-1633