Provider Demographics
NPI:1104086818
Name:OAKVIEW MEDICAL ASSOCIATES LLC
Entity type:Organization
Organization Name:OAKVIEW MEDICAL ASSOCIATES LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT OWNER
Authorized Official - Prefix:
Authorized Official - First Name:NIVEDITA
Authorized Official - Middle Name:S
Authorized Official - Last Name:BIJOOR
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:864-627-0444
Mailing Address - Street 1:PO BOX 12308
Mailing Address - Street 2:
Mailing Address - City:GREENVILLE
Mailing Address - State:SC
Mailing Address - Zip Code:29612-0308
Mailing Address - Country:US
Mailing Address - Phone:864-627-0444
Mailing Address - Fax:864-627-0555
Practice Address - Street 1:215 BATESVILLE RD
Practice Address - Street 2:SUITE B
Practice Address - City:SIMPSONVILLE
Practice Address - State:SC
Practice Address - Zip Code:29681
Practice Address - Country:US
Practice Address - Phone:864-627-0444
Practice Address - Fax:864-627-0555
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-06-16
Last Update Date:2009-02-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC24857207QA0505X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207QA0505XAllopathic & Osteopathic PhysiciansFamily MedicineAdult MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
SC5023Medicaid
SC5023Medicaid