=====================================================
General NPI Number Information
=====================================================
NPI Number | 1598503732
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | OASIS FAMILY HEALTH CENTER LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 07/19/2024
-----------------------------------------------------
Last Update Date | 02/21/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1212 9TH ST STE A
-----------------------------------------------------
City | ALAMOGORDO
-----------------------------------------------------
State | NM
-----------------------------------------------------
Zip | 88310-5842
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 575-488-8888
-----------------------------------------------------
Fax | 575-488-8889
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1212 9TH ST STE A
-----------------------------------------------------
City | ALAMOGORDO
-----------------------------------------------------
State | NM
-----------------------------------------------------
Zip | 88310-5842
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 575-488-8888
-----------------------------------------------------
Fax | 575-488-8889
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER
-----------------------------------------------------
Name | UCHECHUKWU GENEVIEVE KOMOLAFE
-----------------------------------------------------
Credential | DNP
-----------------------------------------------------
Telephone | 850-867-8785
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207Q00000X
-----------------------------------------------------
Taxonomy Name | Family Medicine Physician
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------