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General NPI Number Information
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NPI Number | 1235116708
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Entity Type | Organization
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Legal Business Name | OAKTREE MEDICAL CENTRE, PC
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Dates
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Enumeration Date | 12/27/2005
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Last Update Date | 08/14/2008
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Provider Practice Location Address
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Address Line | 1 CALEDON CT STE. B
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City | GREENVILLE
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State | SC
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Zip | 29615-3192
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Country | US
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Telephone | 864-250-4260
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Fax | 864-250-4261
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Provider Business Mailing Address
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Address Line | PO BOX 484
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City | EASLEY
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State | SC
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Zip | 29641-0484
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Country | US
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Telephone | 864-855-1633
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Fax | 864-855-1323
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. DANIEL A. MCCOLLUM
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Credential |
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Telephone | 864-855-1633
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QP2000X
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Taxonomy Name | Physical Therapy Clinic/Center
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 261QM1300X
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Taxonomy Name | Multi-Specialty Clinic/Center
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License Number |
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License Number State | SC
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