| White Oak Family Medicine Clinic, Llc | |
|
1190 S 18th Street Ext Oxford MS 38655-5378 | |
| (662) 236-1927 | |
| (662) 236-3727 |
| Full Name | White Oak Family Medicine Clinic, Llc |
|---|---|
| Speciality | Clinic/center - Primary Care |
| Location | 1190 S 18th Street Ext, Oxford, Mississippi |
| Authorized Official Name and Position | Erik S Richardson (OWNER) |
| Authorized Official Contact | 6622361927 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| White Oak Family Medicine Clinic, Llc 1190 S 18th Street Ext Oxford MS 38655-5378 Ph: (662) 236-1927 | White Oak Family Medicine Clinic, Llc 1190 S 18th Street Ext Oxford MS 38655-5378 Ph: (662) 236-1927 |
| NPI Number | 1073759502 |
|---|---|
| Provider Enumeration Date | 01/06/2009 |
| Last Update Date | 01/11/2010 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1073759502 | NPI | - | NPPES |
| 302G088746 | Other | MS | GROUP PTAN |
| 302I088746 | Other | MS | INDIVIDUAL PTAN |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QP2300X | Clinic/center - Primary Care | 17356 (Mississippi) | Primary |
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