Provider Demographics
NPI:1356353031
Name:ROXANNE M. OAKLEY
Entity type:Organization
Organization Name:ROXANNE M. OAKLEY
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:ROXANNE
Authorized Official - Middle Name:MABRY
Authorized Official - Last Name:OAKLEY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:662-233-5279
Mailing Address - Street 1:317 HERITAGE DR.
Mailing Address - Street 2:SUITE 2
Mailing Address - City:OXFORD
Mailing Address - State:MS
Mailing Address - Zip Code:38655
Mailing Address - Country:US
Mailing Address - Phone:662-233-5279
Mailing Address - Fax:662-233-6063
Practice Address - Street 1:317 HERITAGE DR.
Practice Address - Street 2:SUITE 2
Practice Address - City:OXFORD
Practice Address - State:MS
Practice Address - Zip Code:38655-5402
Practice Address - Country:US
Practice Address - Phone:662-233-5279
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-12
Last Update Date:2009-04-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS06588/11.1332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS00082313Medicaid
MS5361270001Medicare NSC