| Oasis Lifecare LLC | |
|
1520 Martin St State College PA 16803-3058 | |
| (814) 883-9949 | |
| Not Available |
| Full Name | Oasis Lifecare LLC |
|---|---|
| Speciality | Psychiatry & Neurology |
| Location | 1520 Martin St, State College, Pennsylvania |
| Authorized Official Name and Position | Jason M Lieb (EXECUTIVE OFFICER) |
| Authorized Official Contact | 8148839949 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Oasis Lifecare LLC 1520 Martin St State College PA 16803-3058 | Oasis Lifecare LLC 1520 Martin St State College PA 16803-3058 Ph: (814) 883-9949 |
| NPI Number | 1013398130 |
|---|---|
| Provider Enumeration Date | 06/15/2015 |
| Last Update Date | 07/20/2015 |
| Medicare PECOS PAC ID | 2860796323 |
|---|---|
| Medicare Enrollment ID | O20160204000454 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1013398130 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 2084P0800X | Psychiatry & Neurology - Psychiatry | () | Primary |
| 261QP2300X | Clinic/center - Primary Care | () | Secondary |
| Provider Name | Kristi Barr |
|---|---|
| Provider Type | Practitioner - Physician Assistant |
| Provider Identifiers | NPI Number: 1528021268 PECOS PAC ID: 9638181530 Enrollment ID: I20060614000134 |
| Provider Name | Jason Rock |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1346281367 PECOS PAC ID: 5294822524 Enrollment ID: I20071102000018 |
| Provider Name | Courtney M Hawkins |
|---|---|
| Provider Type | Practitioner - Physician Assistant |
| Provider Identifiers | NPI Number: 1194038562 PECOS PAC ID: 7810180486 Enrollment ID: I20101015000579 |
| Provider Name | Vikrant Mittal |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1194907584 PECOS PAC ID: 0345309654 Enrollment ID: I20110726000725 |
| Provider Name | Ilene Vangilder |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1679839765 PECOS PAC ID: 1951552587 Enrollment ID: I20121108000086 |
| Provider Name | Erin C Crown |
|---|---|
| Provider Type | Practitioner - Physician Assistant |
| Provider Identifiers | NPI Number: 1831535780 PECOS PAC ID: 9335383322 Enrollment ID: I20130912000460 |
| Provider Name | Gwendolyn C Filipowicz |
|---|---|
| Provider Type | Practitioner - Physician Assistant |
| Provider Identifiers | NPI Number: 1447681192 PECOS PAC ID: 0749419984 Enrollment ID: I20140210000954 |
| Provider Name | Michelle Shippert |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1558546747 PECOS PAC ID: 6002090149 Enrollment ID: I20161027001627 |
| Provider Name | Stephanie Ina Mary Struble |
|---|---|
| Provider Type | Practitioner - Physician Assistant |
| Provider Identifiers | NPI Number: 1710416300 PECOS PAC ID: 9133485550 Enrollment ID: I20171117000327 |
| Provider Name | Michael Henry Sullivan Bohr |
|---|---|
| Provider Type | Practitioner - Physician Assistant |
| Provider Identifiers | NPI Number: 1275082992 PECOS PAC ID: 3678853777 Enrollment ID: I20190123000681 |
| Provider Name | Kevin Michael Peno |
|---|---|
| Provider Type | Practitioner - Physician Assistant |
| Provider Identifiers | NPI Number: 1104430503 PECOS PAC ID: 0547689358 Enrollment ID: I20200929000303 |
| Provider Name | Sarah Westin |
|---|---|
| Provider Type | Practitioner - Physician Assistant |
| Provider Identifiers | NPI Number: 1386245827 PECOS PAC ID: 2062820038 Enrollment ID: I20210413001419 |
| Provider Name | Abigail Elizabeth Cummings |
|---|---|
| Provider Type | Practitioner - Physician Assistant |
| Provider Identifiers | NPI Number: 1184226201 PECOS PAC ID: 9931504156 Enrollment ID: I20210928003837 |
| Provider Name | Linnea S Lake |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1205694940 PECOS PAC ID: 7113368549 Enrollment ID: I20240515003905 |
| Provider Name | Natalie Reiss |
|---|---|
| Provider Type | Practitioner - Clinical Psychologist |
| Provider Identifiers | NPI Number: 1659781052 PECOS PAC ID: 5395003495 Enrollment ID: I20240717003101 |
| Provider Name | Matthew F. Wagner |
|---|---|
| Provider Type | Practitioner - Mental Health Counselor |
| Provider Identifiers | NPI Number: 1174973432 PECOS PAC ID: 5890283527 Enrollment ID: I20251023002374 |
| Provider Name | Meagan Earnest |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1467139022 PECOS PAC ID: 3375034788 Enrollment ID: I20251113002740 |
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