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Organization
OASIS MEDICAL GROUP, LLC
Active
Organization
OASIS MEDICAL GROUP, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
NICOLE MITCHELL (OWNER)
(928) 453-1101
Entity
Organization
Contact information
Practice address
2035 MESQUITE AVE, SUITE C, LAKE HAVASU CITY, AZ 86403-5894
(928) 453-1101
(928) 453-1171
Mailing address
P.O. BOX 1185, LAKE HAVASU CITY, AZ 86405-1185
(928) 453-1101
(928) 453-1171
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
—
NULL
207Q00000X
Family Medicine Physician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
535744
—
AZ
01
—
L-1602910-3
AZ LLC REGISTRATION
AZ
Enumeration date
07/08/2010
Last updated
02/16/2011
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