Provider Demographics
NPI:1942582036
Name:OAC MANAGEMENT LLC
Entity Type:Organization
Organization Name:OAC MANAGEMENT LLC
Other - Org Name:OSTEOARTHRITIS CENTERS OF AMERICA
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MANAGING PARTNER
Authorized Official - Prefix:
Authorized Official - First Name:DERK
Authorized Official - Middle Name:
Authorized Official - Last Name:PARDOE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:801-808-2357
Mailing Address - Street 1:3454 STONE MOUNTAIN LN
Mailing Address - Street 2:
Mailing Address - City:SANDY
Mailing Address - State:UT
Mailing Address - Zip Code:84092-6549
Mailing Address - Country:US
Mailing Address - Phone:801-688-7441
Mailing Address - Fax:
Practice Address - Street 1:5589 GREENWICH RD
Practice Address - Street 2:SUITE 175
Practice Address - City:VIRGINIA BEACH
Practice Address - State:VA
Practice Address - Zip Code:23462-6565
Practice Address - Country:US
Practice Address - Phone:757-216-9115
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:A I G INVESTMENTS LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2011-09-14
Last Update Date:2012-02-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA261QM1300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM1300XAmbulatory Health Care FacilitiesClinic/CenterMulti-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
VAA676Medicare PIN