Provider Demographics
NPI:1487794319
Name:OAKTREE MEDICAL CENTRE, PC
Entity type:Organization
Organization Name:OAKTREE MEDICAL CENTRE, PC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:DANIEL
Authorized Official - Middle Name:A
Authorized Official - Last Name:MCCOLLUM
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:864-855-1633
Mailing Address - Street 1:PO BOX 484
Mailing Address - Street 2:
Mailing Address - City:EASLEY
Mailing Address - State:SC
Mailing Address - Zip Code:29641-0484
Mailing Address - Country:US
Mailing Address - Phone:864-855-1633
Mailing Address - Fax:864-855-1323
Practice Address - Street 1:138 MILESTONE WAY
Practice Address - Street 2:SUITE A
Practice Address - City:GREENVILLE
Practice Address - State:SC
Practice Address - Zip Code:29615-6617
Practice Address - Country:US
Practice Address - Phone:864-288-9936
Practice Address - Fax:864-288-9937
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-08
Last Update Date:2007-10-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QM2500XAmbulatory Health Care FacilitiesClinic/CenterMedical Specialty
No2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurologyGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCGP2763Medicaid
SCGP2763Medicaid