Provider Demographics
NPI:1386652659
Name:MARY K. OATES, M.D. INC
Entity Type:Organization
Organization Name:MARY K. OATES, M.D. INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:MARY
Authorized Official - Middle Name:KOSKO
Authorized Official - Last Name:OATES
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:805-922-4224
Mailing Address - Street 1:116 S PALISADE DR
Mailing Address - Street 2:STE. #200
Mailing Address - City:SANTA MARIA
Mailing Address - State:CA
Mailing Address - Zip Code:93454-8904
Mailing Address - Country:US
Mailing Address - Phone:805-922-4224
Mailing Address - Fax:805-922-6101
Practice Address - Street 1:116 S PALISADE DR
Practice Address - Street 2:STE. #200
Practice Address - City:SANTA MARIA
Practice Address - State:CA
Practice Address - Zip Code:93454-8904
Practice Address - Country:US
Practice Address - Phone:805-922-4224
Practice Address - Fax:805-922-6101
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-03
Last Update Date:2008-02-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAGO72476207P00000X
CAGO72477208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationGroup - Multi-Specialty
No207P00000XAllopathic & Osteopathic PhysiciansEmergency MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAWG72477CMedicare PIN
CAF81908Medicare UPIN
CAG72477Medicare PIN
CAF53690Medicare UPIN
CAG72476Medicare PIN
CAW21194AMedicare PIN