MEDICARE: OVERSEER, LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	251S00000X	Community/Behavioral Health Agency

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1205085644
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	OVERSEER, LLC

Provider Business Mailing Address
First Line	:	PO BOX 1369
Second Line	:
City	:	WADESBORO
State	:	NC
Zip	:	28170-1431
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	202 GREENWOOD LN
Second Line	:
City	:	WADESBORO
State	:	NC
Zip	:	28170-2207
Country	:	US
Telephone Number	:	704-694-0144
Fax Number	:

Authorized Official
Title or Position	:	CEO
Name	:	MR. JOE CLAY PARKER
Credential	:
Telephone Number	:	704-940-1288

Provider Enumeration Date	:	09/10/2008
Last Update Date	:	09/10/2008

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