Basic Information
Provider Information | |||||||||
NPI: | 1619944170 | ||||||||
EntityType: | 2 | ||||||||
ReplacementNPI: |   | ||||||||
OrganizationName: | OASIS OBSTETRICS & GYNECOLOGY, PLC | ||||||||
LastName: |   | ||||||||
FirstName: |   | ||||||||
MiddleName: |   | ||||||||
NamePrefix: |   | ||||||||
NameSuffix: |   | ||||||||
Credential: |   | ||||||||
OtherOrganizationName: |   | ||||||||
OtherOrganizationType: |   | ||||||||
OtherLastName: |   | ||||||||
OtherFirstName: |   | ||||||||
OtherMiddleName: |   | ||||||||
OtherNamePrefix: |   | ||||||||
OtherNameSuffix: |   | ||||||||
OtherCredential: |   | ||||||||
OtherLastNameType: |   | ||||||||
Mailing Information | |||||||||
Address1: | 81 W. GUADALUPE ROAD | ||||||||
Address2: | SUITE 111 | ||||||||
City: | GILBERT | ||||||||
State: | AZ | ||||||||
PostalCode: | 85233 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 4808542676 | ||||||||
FaxNumber: | 4808543618 | ||||||||
Practice Location | |||||||||
Address1: | 81 W. GUADALUPE ROAD | ||||||||
Address2: | SUITE 111 | ||||||||
City: | GILBERT | ||||||||
State: | AZ | ||||||||
PostalCode: | 85233 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 4808542676 | ||||||||
FaxNumber: | 4808543618 | ||||||||
Other Information | |||||||||
ProviderEnumerationDate: | 03/03/2006 | ||||||||
LastUpdateDate: | 09/29/2014 | ||||||||
NPIDeactivationReasonCode: |   | ||||||||
NPIDeactivationDate: |   | ||||||||
NPIReactivationDate: |   | ||||||||
ProviderGenderCode: |   | ||||||||
AuthorizedOfficialLastName: | MESSER | ||||||||
AuthorizedOfficialFirstName: | SHELLY | ||||||||
AuthorizedOfficialMiddleName: | R. | ||||||||
AuthorizedOfficialTitleorPosition: | OWNER | ||||||||
AuthorizedOfficialTelephone: | 4808542676 | ||||||||
IsSoleProprietor: |   | ||||||||
IsOrganizationSubpart: | N | ||||||||
ParentOrganizationLBN: |   | ||||||||
AuthorizedOfficialNamePrefix: | DR. | ||||||||
AuthorizedOfficialNameSuffix: |   | ||||||||
AuthorizedOfficialCredential: | M.D. | ||||||||
NPICertificationDate: |   |
Taxonomy Information
Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207V00000X |   |   | N | 193200000X MULTI-SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Obstetrics & Gynecology |   | 207V00000X | 28636 | AZ | Y | 193200000X MULTI-SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Obstetrics & Gynecology |   |
ID Information
ID | Type | State | Issuer | Description | 561929 | 05 | AZ |   | MEDICAID |