Provider Demographics
NPI:1912711169
Name:OAK STREET HEALTH PHYSICIAN GROUP OF DELAWARE LLC
Entity type:Organization
Organization Name:OAK STREET HEALTH PHYSICIAN GROUP OF DELAWARE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CMO, OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:TERRENCE
Authorized Official - Middle Name:D
Authorized Official - Last Name:MORTON
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:704-607-4835
Mailing Address - Street 1:PO BOX 746763
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30374-6763
Mailing Address - Country:US
Mailing Address - Phone:773-352-1515
Mailing Address - Fax:312-929-0373
Practice Address - Street 1:800 W 4TH ST STE 501
Practice Address - Street 2:
Practice Address - City:WILMINGTON
Practice Address - State:DE
Practice Address - Zip Code:19801-2054
Practice Address - Country:US
Practice Address - Phone:302-295-4730
Practice Address - Fax:302-487-1689
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-02-06
Last Update Date:2025-02-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care