Provider Demographics
NPI: | 1457641011 |
---|---|
Name: | OAKWOOD PROFESSIONAL BILLING, LLC |
Entity Type: | Organization |
Organization Name: | OAKWOOD PROFESSIONAL BILLING, LLC |
Other - Org Name: | WILLIE B GIBSON MD PC |
Other - Org Type: | Doing Business As |
Authorized Official - Title/Position: | PRESIDENT SHARED SERVICES |
Authorized Official - Prefix: | |
Authorized Official - First Name: | LEE |
Authorized Official - Middle Name: | ANN |
Authorized Official - Last Name: | ODOM |
Authorized Official - Suffix: | |
Authorized Official - Credentials: | |
Authorized Official - Phone: | 947-522-3326 |
Mailing Address - Street 1: | 26901 BEAUMONT BLVD |
Mailing Address - Street 2: | COMPLIANCE |
Mailing Address - City: | SOUTHFIELD |
Mailing Address - State: | MI |
Mailing Address - Zip Code: | 48033-3849 |
Mailing Address - Country: | US |
Mailing Address - Phone: | 947-522-1964 |
Mailing Address - Fax: | |
Practice Address - Street 1: | 18300 W MCNICHOLS RD |
Practice Address - Street 2: | |
Practice Address - City: | DETROIT |
Practice Address - State: | MI |
Practice Address - Zip Code: | 48219-4162 |
Practice Address - Country: | US |
Practice Address - Phone: | 313-535-9366 |
Practice Address - Fax: | |
EIN: | <UNAVAIL> |
Is Organization Subpart?: | No |
Parent Organization LBN: | |
Parent Organization TIN: | |
Enumeration Date: | 2011-04-15 |
Last Update Date: | 2021-10-21 |
Deactivation Date: | |
Deactivation Code: | |
Reactivation Date: |
Provider Taxonomies
Primary? | Code | Type | Classification | Specialization | Group |
---|---|---|---|---|---|
Yes | 208D00000X | Allopathic & Osteopathic Physicians | General Practice | Group - Single Specialty |