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General NPI Number Information
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NPI Number | 1043421357
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Entity Type | Organization
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Legal Business Name | URGENT CARE CLINIC OF OXFORD
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Dates
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Enumeration Date | 05/25/2007
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Last Update Date | 03/23/2011
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Provider Practice Location Address
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Address Line | 1487 BELK BLVD
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City | OXFORD
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State | MS
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Zip | 38655-5371
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Country | US
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Telephone | 662-234-1090
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Fax | 662-234-0432
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Provider Business Mailing Address
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Address Line | 1487 BELK BLVD
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City | OXFORD
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State | MS
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Zip | 38655-5371
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Country | US
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Telephone | 662-234-1090
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Fax | 662-234-0432
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Authorized Official
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Title or Position | OFFICE MANAGER
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Name | MRS. KELLEY DENISE MCCULLOUGH
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Credential |
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Telephone | 662-234-1090
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | 18438
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License Number State | MS
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Taxonomy #2
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | 10602
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License Number State | MS
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Taxonomy #3
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Taxonomy Code | 363L00000X
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Taxonomy Name | Nurse Practitioner
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License Number | R728594
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License Number State | MS
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Taxonomy #4
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | 13516
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License Number State | MS
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