Provider Demographics
NPI:1790806396
Name:OXFORD BARIATRIC, GENERAL & METABOLIC SURGERY, PLLC
Entity Type:Organization
Organization Name:OXFORD BARIATRIC, GENERAL & METABOLIC SURGERY, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:MICKI
Authorized Official - Middle Name:
Authorized Official - Last Name:JOHNSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:662-234-3303
Mailing Address - Street 1:2215 JEFFERSON DAVIS DR
Mailing Address - Street 2:
Mailing Address - City:OXFORD
Mailing Address - State:MS
Mailing Address - Zip Code:38655-5221
Mailing Address - Country:US
Mailing Address - Phone:662-234-3303
Mailing Address - Fax:662-232-8936
Practice Address - Street 1:2215 JEFFERSON DAVIS DR
Practice Address - Street 2:
Practice Address - City:OXFORD
Practice Address - State:MS
Practice Address - Zip Code:38655-5221
Practice Address - Country:US
Practice Address - Phone:662-234-3303
Practice Address - Fax:662-232-8936
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-02
Last Update Date:2009-08-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208600000XAllopathic & Osteopathic PhysiciansSurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS0118175Medicaid
MS00125938Medicaid
MS57505Medicare UPIN
MS020000434Medicare ID - Type UnspecifiedRICHARD W. BYARS, MD
MS00125938Medicaid
MS0118175Medicaid