| Oasis Lifecare Llc | |
|
1520 Martin St State College PA 16803-3058 | |
| (814) 883-9949 | |
| Not Available |
| Full Name | Oasis Lifecare Llc |
|---|---|
| Speciality | Psychiatry & Neurology |
| Location | 1520 Martin St, State College, Pennsylvania |
| Authorized Official Name and Position | Jason M Lieb (EXECUTIVE OFFICER) |
| Authorized Official Contact | 8148839949 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Oasis Lifecare Llc 1520 Martin St State College PA 16803-3058 Ph: () - | Oasis Lifecare Llc 1520 Martin St State College PA 16803-3058 Ph: (814) 883-9949 |
| NPI Number | 1013398130 |
|---|---|
| Provider Enumeration Date | 06/15/2015 |
| Last Update Date | 07/20/2015 |
| Medicare PECOS PAC ID | 2860796323 |
|---|---|
| Medicare Enrollment ID | O20160204000454 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1013398130 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 2084P0800X | Psychiatry & Neurology - Psychiatry | (* (Not Available)) | Primary |
| 261QP2300X | Clinic/center - Primary Care | (* (Not Available)) | Secondary |
| Provider Name | Jason Rock |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1346281367 PECOS PAC ID: 5294822524 Enrollment ID: I20071102000018 |
| Provider Name | Vikrant Mittal |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1194907584 PECOS PAC ID: 0345309654 Enrollment ID: I20110726000725 |
| Provider Name | Ilene Vangilder |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1679839765 PECOS PAC ID: 1951552587 Enrollment ID: I20121108000086 |
| Provider Name | Randy A Smith |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1346515251 PECOS PAC ID: 9638474471 Enrollment ID: I20160216002333 |
| Provider Name | Michelle Shippert |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1558546747 PECOS PAC ID: 6002090149 Enrollment ID: I20161027001627 |
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