Provider Demographics
NPI:1205007010
Name:OSBORNE'S OXYGEN SERVICE
Entity Type:Organization
Organization Name:OSBORNE'S OXYGEN SERVICE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER & PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:DEWITT
Authorized Official - Last Name:OSBORNE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:336-244-2038
Mailing Address - Street 1:14634 ELKIN HIGHWAY 268
Mailing Address - Street 2:
Mailing Address - City:RONDA
Mailing Address - State:NC
Mailing Address - Zip Code:28670-9179
Mailing Address - Country:US
Mailing Address - Phone:336-244-2038
Mailing Address - Fax:336-526-8329
Practice Address - Street 1:14634 ELKIN HIGHWAY 268
Practice Address - Street 2:
Practice Address - City:RONDA
Practice Address - State:NC
Practice Address - Zip Code:28670-9179
Practice Address - Country:US
Practice Address - Phone:336-244-2038
Practice Address - Fax:336-526-8329
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-03-19
Last Update Date:2008-03-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC702332BX2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332BX2000XSuppliersDurable Medical Equipment & Medical SuppliesOxygen Equipment & Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC7703617Medicaid
NC4564040001Medicare NSC