Provider Demographics
NPI:1013946920
Name:PSIMED OASIS, LLC
Entity Type:Organization
Organization Name:PSIMED OASIS, LLC
Other - Org Name:OASIS, LLC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DIRECTOR OF FINANCE
Authorized Official - Prefix:MS
Authorized Official - First Name:FREDDIE
Authorized Official - Middle Name:V
Authorized Official - Last Name:SIZEMORE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:304-776-7606
Mailing Address - Street 1:PO BOX 7310
Mailing Address - Street 2:
Mailing Address - City:CHARLESTON
Mailing Address - State:WV
Mailing Address - Zip Code:25356-0310
Mailing Address - Country:US
Mailing Address - Phone:304-776-7606
Mailing Address - Fax:304-776-7636
Practice Address - Street 1:100 PEYTON WAY
Practice Address - Street 2:
Practice Address - City:CHARLESTON
Practice Address - State:WV
Practice Address - Zip Code:25309-8572
Practice Address - Country:US
Practice Address - Phone:304-720-8466
Practice Address - Fax:304-720-8463
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-02
Last Update Date:2008-06-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologistGroup - Multi-Specialty
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Multi-Specialty
No1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WV4004010000Medicaid
WVPS9355291Medicare PIN