Provider Demographics
NPI:1609623198
Name:OASIS HEALTH CLINIC PLLC
Entity type:Organization
Organization Name:OASIS HEALTH CLINIC PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEDICAL DIRECTOR/CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:VICTOR
Authorized Official - Middle Name:S
Authorized Official - Last Name:JACKSON
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:409-539-5312
Mailing Address - Street 1:5826 BROADWAY ST STE 3734
Mailing Address - Street 2:
Mailing Address - City:GALVESTON
Mailing Address - State:TX
Mailing Address - Zip Code:77551-4385
Mailing Address - Country:US
Mailing Address - Phone:409-539-5312
Mailing Address - Fax:409-207-5016
Practice Address - Street 1:1701 23RD ST
Practice Address - Street 2:
Practice Address - City:GALVESTON
Practice Address - State:TX
Practice Address - Zip Code:77550-7901
Practice Address - Country:US
Practice Address - Phone:409-539-5312
Practice Address - Fax:409-207-5016
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-05-02
Last Update Date:2024-09-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty