Provider Demographics
NPI:1093269995
Name:CENTER FOR REGENERATIVE ORTHOPEDIC MEDICINE, PC
Entity Type:Organization
Organization Name:CENTER FOR REGENERATIVE ORTHOPEDIC MEDICINE, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:CARL
Authorized Official - Middle Name:
Authorized Official - Last Name:OSBORN
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:541-842-7777
Mailing Address - Street 1:786 STATE ST
Mailing Address - Street 2:
Mailing Address - City:MEDFORD
Mailing Address - State:OR
Mailing Address - Zip Code:97504-8441
Mailing Address - Country:US
Mailing Address - Phone:541-842-7777
Mailing Address - Fax:541-842-4310
Practice Address - Street 1:786 STATE ST
Practice Address - Street 2:
Practice Address - City:MEDFORD
Practice Address - State:OR
Practice Address - Zip Code:97504-8441
Practice Address - Country:US
Practice Address - Phone:541-842-7777
Practice Address - Fax:541-842-4310
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-08-09
Last Update Date:2016-08-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORDO22851208VP0014X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208VP0014XAllopathic & Osteopathic PhysiciansPain MedicineInterventional Pain MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR1255431151OtherNPI 1255431151