Provider Demographics
NPI:1730523697
Name:OASIS PHYSICAL MEDICINE
Entity type:Organization
Organization Name:OASIS PHYSICAL MEDICINE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEDICAL DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:GREEN
Authorized Official - Middle Name:B
Authorized Official - Last Name:NEAL
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:803-786-0559
Mailing Address - Street 1:4010 N MAIN ST
Mailing Address - Street 2:SUITE 2
Mailing Address - City:COLUMBIA
Mailing Address - State:SC
Mailing Address - Zip Code:29203-5848
Mailing Address - Country:US
Mailing Address - Phone:803-786-0559
Mailing Address - Fax:803-786-1307
Practice Address - Street 1:4010 N MAIN ST
Practice Address - Street 2:SUITE 2
Practice Address - City:COLUMBIA
Practice Address - State:SC
Practice Address - Zip Code:29203-5848
Practice Address - Country:US
Practice Address - Phone:803-786-0559
Practice Address - Fax:803-786-1307
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-04-23
Last Update Date:2013-04-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA533818111NN1001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111NN1001XChiropractic ProvidersChiropractorNutritionGroup - Single Specialty