Healthcare Provider Details

I. General information

NPI: 1306243829
Provider Name (Legal Business Name): OASIS MEDICAL LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/26/2014
Last Update Date: 11/26/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

325 FRONT ST #330
EVANSTON WY
82930-3633
US

IV. Provider business mailing address

325 FRONT ST #330
EVANSTON WY
82930-3633
US

V. Phone/Fax

Practice location:
  • Phone: 877-254-7838
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code332BC3200X
TaxonomyCustomized Equipment (DME)
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code335E00000X
TaxonomyProsthetic/Orthotic Supplier
License Number
License Number State

VIII. Authorized Official

Name: MR. SETH KELSON
Title or Position: PRESIDENT
Credential:
Phone: 801-230-2018