Provider Demographics
NPI:1023042033
Name:OXFORD ORTHOPAEDICS AND SPORTS MEDICINE PLLC
Entity Type:Organization
Organization Name:OXFORD ORTHOPAEDICS AND SPORTS MEDICINE PLLC
Other - Org Name:OXFORD SURGICAL SPECIALISTS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:COOPER
Authorized Official - Middle Name:LOOMIS
Authorized Official - Last Name:TERRY
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:662-513-2000
Mailing Address - Street 1:497 AZALEA DR
Mailing Address - Street 2:SUITE 102
Mailing Address - City:OXFORD
Mailing Address - State:MS
Mailing Address - Zip Code:38655-7905
Mailing Address - Country:US
Mailing Address - Phone:662-513-2000
Mailing Address - Fax:662-513-2001
Practice Address - Street 1:497 AZALEA DR
Practice Address - Street 2:SUITE 102
Practice Address - City:OXFORD
Practice Address - State:MS
Practice Address - Zip Code:38655-7905
Practice Address - Country:US
Practice Address - Phone:662-513-2000
Practice Address - Fax:662-513-2001
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-10
Last Update Date:2019-04-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207XX0005XAllopathic & Osteopathic PhysiciansOrthopaedic SurgerySports MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS09014847Medicaid
MS1023042033OtherGROUP NPI
MS4204200001Medicare NSC