Provider Demographics
NPI:1649775123
Name:OXFORD OUTPATIENT CENTER, LLC
Entity Type:Organization
Organization Name:OXFORD OUTPATIENT CENTER, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:FACILITY CEO
Authorized Official - Prefix:
Authorized Official - First Name:MARK
Authorized Official - Middle Name:
Authorized Official - Last Name:STOVALL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:662-281-9992
Mailing Address - Street 1:200 POWELL PL
Mailing Address - Street 2:ATTN: LEGAL DEPARTMENT
Mailing Address - City:BRENTWOOD
Mailing Address - State:TN
Mailing Address - Zip Code:37027-7514
Mailing Address - Country:US
Mailing Address - Phone:615-732-1605
Mailing Address - Fax:
Practice Address - Street 1:611 COMMERCE PKWY
Practice Address - Street 2:
Practice Address - City:OXFORD
Practice Address - State:MS
Practice Address - Zip Code:38655
Practice Address - Country:US
Practice Address - Phone:615-727-8416
Practice Address - Fax:615-457-8094
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-03-27
Last Update Date:2021-09-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MSOOC-AGENCY261QR0405X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR0405XAmbulatory Health Care FacilitiesClinic/CenterRehabilitation, Substance Use Disorder