Provider Demographics
NPI:1184815052
Name:OSTEOPATHIC CARE, INC
Entity Type:Organization
Organization Name:OSTEOPATHIC CARE, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:SHARON
Authorized Official - Middle Name:M
Authorized Official - Last Name:GUSTOWSKI
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:702-249-9351
Mailing Address - Street 1:PO BOX 60553
Mailing Address - Street 2:
Mailing Address - City:BOULDER CITY
Mailing Address - State:NV
Mailing Address - Zip Code:89006-0553
Mailing Address - Country:US
Mailing Address - Phone:702-249-9351
Mailing Address - Fax:
Practice Address - Street 1:893 ADAMS BLVD
Practice Address - Street 2:
Practice Address - City:BOULDER CITY
Practice Address - State:NV
Practice Address - Zip Code:89005-2235
Practice Address - Country:US
Practice Address - Phone:702-249-9351
Practice Address - Fax:702-293-0845
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-08-06
Last Update Date:2010-08-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV1190204D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes204D00000XAllopathic & Osteopathic PhysiciansNeuromusculoskeletal Medicine & OMMGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NVV104538Medicare PIN