Provider Demographics
NPI:1912440207
Name:OSCAR MEDICAL , INC
Entity Type:Organization
Organization Name:OSCAR MEDICAL , INC
Other - Org Name:OSCAR MEDICAL CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MEDICAL DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:IGWEBUIKE
Authorized Official - Middle Name:
Authorized Official - Last Name:OSCAR MEDICAL CENTER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:470-355-2340
Mailing Address - Street 1:3375 MEMORIAL DR
Mailing Address - Street 2:
Mailing Address - City:DECATUR
Mailing Address - State:GA
Mailing Address - Zip Code:30032-2706
Mailing Address - Country:US
Mailing Address - Phone:470-355-2340
Mailing Address - Fax:
Practice Address - Street 1:3375 MEMORIAL DR
Practice Address - Street 2:
Practice Address - City:DECATUR
Practice Address - State:GA
Practice Address - Zip Code:30032-2706
Practice Address - Country:US
Practice Address - Phone:470-355-2340
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:OSCAR MEDICAL CENTER
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2016-11-18
Last Update Date:2023-06-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
261QP2300X
GA039650261QU0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QU0200XAmbulatory Health Care FacilitiesClinic/CenterUrgent Care
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care