Provider Demographics
NPI:1578111936
Name:OASIS MEDICAL GROUP CLINIC, LLC
Entity Type:Organization
Organization Name:OASIS MEDICAL GROUP CLINIC, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN ASSITANT/CEO
Authorized Official - Prefix:
Authorized Official - First Name:JOSE
Authorized Official - Middle Name:MANUEL
Authorized Official - Last Name:ALMANZAR
Authorized Official - Suffix:
Authorized Official - Credentials:PHYSICIAN ASSISTANT
Authorized Official - Phone:239-285-6649
Mailing Address - Street 1:7385 RADIO RD STE 104-D
Mailing Address - Street 2:
Mailing Address - City:NAPLES
Mailing Address - State:FL
Mailing Address - Zip Code:34104-6704
Mailing Address - Country:US
Mailing Address - Phone:239-434-6000
Mailing Address - Fax:239-434-6018
Practice Address - Street 1:7385 RADIO RD STE 104-D
Practice Address - Street 2:
Practice Address - City:NAPLES
Practice Address - State:FL
Practice Address - Zip Code:34104-6704
Practice Address - Country:US
Practice Address - Phone:239-434-6000
Practice Address - Fax:239-434-6018
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-08-29
Last Update Date:2019-08-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty