Provider Demographics
NPI:1043413966
Name:OSAGE DIAGNOSTICS
Entity Type:Organization
Organization Name:OSAGE DIAGNOSTICS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:
Authorized Official - Last Name:CHOUTEAU
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:214-340-5090
Mailing Address - Street 1:9262 FOREST LN
Mailing Address - Street 2:STE. 101B
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75243-4207
Mailing Address - Country:US
Mailing Address - Phone:214-340-5090
Mailing Address - Fax:214-340-7287
Practice Address - Street 1:9262 FOREST LN
Practice Address - Street 2:STE. 101B
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75243-4207
Practice Address - Country:US
Practice Address - Phone:214-340-5090
Practice Address - Fax:214-340-7287
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-06-07
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Not Answered208VP0000XAllopathic & Osteopathic PhysiciansPain MedicinePain MedicineGroup - Single Specialty
Not Answered261QR0800XAmbulatory Health Care FacilitiesClinic/CenterRecovery CareGroup - Single Specialty