# OASIS MEDICAL GROUP, LLC

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1114239019
- **Authorized official:** NICOLE MITCHELL (OWNER)
- **Authorized official phone:** (928) 453-1101

## Contact information

- **Practice address:** 2035 MESQUITE AVE, SUITE C, LAKE HAVASU CITY, AZ 86403-5894
- **Practice address phone:** (928) 453-1101
- **Practice address fax:** (928) 453-1171
- **Mailing address:** P.O. BOX 1185, LAKE HAVASU CITY, AZ 86405-1185
- **Mailing address phone:** (928) 453-1101
- **Mailing address fax:** (928) 453-1171

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 207Q00000X | Family Medicine Physician | — | NULL | Yes |
| 207Q00000X | Family Medicine Physician | — | — | Yes |

## Other

- **Enumeration date:** 07/08/2010
- **Last updated:** 02/16/2011

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 05 | — | 535744 | — | AZ |
| 01 | — | L-1602910-3 | AZ LLC REGISTRATION | AZ |