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General NPI Number Information
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NPI Number | 1174904239
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Entity Type | Organization
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Legal Business Name | OXFORD VEIN CENTER PLLC
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Dates
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Enumeration Date | 06/15/2015
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Last Update Date | 06/23/2015
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Provider Practice Location Address
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Address Line | 300 ENTERPRISE DR SUITE B
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City | OXFORD
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State | MS
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Zip | 38655-2762
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Country | US
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Telephone | 662-638-3677
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Fax | 662-638-3678
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Provider Business Mailing Address
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Address Line | 300 ENTERPRISE DR SUITE B
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City | OXFORD
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State | MS
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Zip | 38655-2762
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Country | US
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Telephone | 662-638-3677
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Fax | 662-638-3678
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Authorized Official
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Title or Position | OWNER
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Name | CHRISTINE WALDROP
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Credential | MD
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Telephone | 662-638-3677
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207L00000X
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Taxonomy Name | Anesthesiology Physician
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License Number | 20317
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License Number State | MS
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Taxonomy #2
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Taxonomy Code | 202K00000X
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Taxonomy Name | Phlebology Physician
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License Number | 20317
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License Number State | MS
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