Provider Demographics
NPI:1659869238
Name:OASIS MEDICAL PROVIDERS, LLC
Entity Type:Organization
Organization Name:OASIS MEDICAL PROVIDERS, LLC
Other - Org Name:OASIS MEDICAL
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MANAGER/PROVIDER
Authorized Official - Prefix:MR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:P
Authorized Official - Last Name:CROYLE
Authorized Official - Suffix:JR
Authorized Official - Credentials:PA-C
Authorized Official - Phone:814-571-5504
Mailing Address - Street 1:1096 DORADO DR
Mailing Address - Street 2:
Mailing Address - City:SAINT AUGUSTINE
Mailing Address - State:FL
Mailing Address - Zip Code:32086-7075
Mailing Address - Country:US
Mailing Address - Phone:814-571-5504
Mailing Address - Fax:
Practice Address - Street 1:316 PASEO REYES DR
Practice Address - Street 2:
Practice Address - City:SAINT AUGUSTINE
Practice Address - State:FL
Practice Address - Zip Code:32095-8464
Practice Address - Country:US
Practice Address - Phone:904-342-0219
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-04-29
Last Update Date:2018-04-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care