Provider Demographics
NPI:1043421357
Name:URGENT CARE CLINIC OF OXFORD
Entity Type:Organization
Organization Name:URGENT CARE CLINIC OF OXFORD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:KELLEY
Authorized Official - Middle Name:DENISE
Authorized Official - Last Name:MCCULLOUGH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:662-234-1090
Mailing Address - Street 1:1487 BELK BLVD
Mailing Address - Street 2:
Mailing Address - City:OXFORD
Mailing Address - State:MS
Mailing Address - Zip Code:38655-5371
Mailing Address - Country:US
Mailing Address - Phone:662-234-1090
Mailing Address - Fax:662-234-0432
Practice Address - Street 1:1487 BELK BLVD
Practice Address - Street 2:
Practice Address - City:OXFORD
Practice Address - State:MS
Practice Address - Zip Code:38655-5371
Practice Address - Country:US
Practice Address - Phone:662-234-1090
Practice Address - Fax:662-234-0432
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-25
Last Update Date:2011-03-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS13516207Q00000X
MS18438207Q00000X
MS10602207Q00000X
MSR728594363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS0015608Medicaid
MS06759064Medicaid
MS9014432Medicaid
MS080002219Medicare ID - Type Unspecified
MS080002113Medicare ID - Type Unspecified
MS0015608Medicaid
MS06759064Medicaid
MSP03979Medicare UPIN
MS9014432Medicaid
080004078Medicare ID - Type Unspecified
MS080004078Medicare ID - Type Unspecified