Provider Demographics
NPI:1750646436
Name:OXFORD PRE OP & IMAGING CENTER LLC
Entity Type:Organization
Organization Name:OXFORD PRE OP & IMAGING CENTER LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SECRETARY
Authorized Official - Prefix:
Authorized Official - First Name:RICHARD
Authorized Official - Middle Name:WALKER
Authorized Official - Last Name:BYARS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:662-234-4744
Mailing Address - Street 1:PO BOX 578
Mailing Address - Street 2:
Mailing Address - City:OXFORD
Mailing Address - State:MS
Mailing Address - Zip Code:38655-0578
Mailing Address - Country:US
Mailing Address - Phone:662-234-5545
Mailing Address - Fax:662-234-5589
Practice Address - Street 1:1202 OFFICE PARK DR
Practice Address - Street 2:SUITE B
Practice Address - City:OXFORD
Practice Address - State:MS
Practice Address - Zip Code:38655-5267
Practice Address - Country:US
Practice Address - Phone:662-234-5545
Practice Address - Fax:662-234-5589
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-07-10
Last Update Date:2014-02-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
261QH0100X
MS36-2-026261QR0200X
MS25D2049358291U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR0200XAmbulatory Health Care FacilitiesClinic/CenterRadiology
No261QH0100XAmbulatory Health Care FacilitiesClinic/CenterHealth Service
No291U00000XLaboratoriesClinical Medical Laboratory
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS02005001Medicaid
265886OtherMEDICARE PTAN