Provider Demographics
NPI:1730135773
Name:OASIS SURGICAL PROF CORP
Entity Type:Organization
Organization Name:OASIS SURGICAL PROF CORP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:DR
Authorized Official - First Name:PAUL
Authorized Official - Middle Name:A
Authorized Official - Last Name:CARMICHAEL
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:209-632-2960
Mailing Address - Street 1:880 E TUOLUMNE RD
Mailing Address - Street 2:201
Mailing Address - City:TURLOCK
Mailing Address - State:CA
Mailing Address - Zip Code:95382-1548
Mailing Address - Country:US
Mailing Address - Phone:209-632-2960
Mailing Address - Fax:209-632-2062
Practice Address - Street 1:880 E TUOLUMNE RD
Practice Address - Street 2:SUITE 201
Practice Address - City:TURLOCK
Practice Address - State:CA
Practice Address - Zip Code:95382-1548
Practice Address - Country:US
Practice Address - Phone:209-632-2960
Practice Address - Fax:209-632-2062
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-25
Last Update Date:2007-07-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208600000XAllopathic & Osteopathic PhysiciansSurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAZZZ64148ZOtherBLUE SHIELD OF CALIFORNIA
CAZZZ64148ZOtherCHAMPUS/TRICARE
CAGR0100260Medicaid
CAZZZ320482Medicare ID - Type Unspecified