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General NPI Number Information
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NPI Number | 1649775123
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Entity Type | Organization
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Legal Business Name | OXFORD OUTPATIENT CENTER, LLC
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Dates
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Enumeration Date | 03/27/2018
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Last Update Date | 10/11/2024
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Provider Practice Location Address
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Address Line | 611 COMMERCE PKWY
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City | OXFORD
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State | MS
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Zip | 38655
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Country | US
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Telephone | 615-727-8416
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Fax | 615-457-8094
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Provider Business Mailing Address
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Address Line | 500 WILSON PIKE CIR STE 360
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City | BRENTWOOD
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State | TN
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Zip | 37027-3266
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | DIRECTOR OF OUTPATIENT OPERATIONS
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Name | MS. KEISHA WYNN
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Credential | MSN, RN
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Telephone | 828-215-1455
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QR0405X
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Taxonomy Name | Substance Use Disorder Rehabilitation Clinic/Center
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License Number | OOC-AGENCY
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License Number State | MS
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