Provider Demographics
NPI:1336289990
Name:SUSAN PAGE OSBORNE
Entity Type:Organization
Organization Name:SUSAN PAGE OSBORNE
Other - Org Name:THE BARTER CLINIC
Other - Org Type:Other Name
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:SUSAN
Authorized Official - Middle Name:
Authorized Official - Last Name:OSBORNE
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:540-745-6034
Mailing Address - Street 1:PO BOX 597
Mailing Address - Street 2:
Mailing Address - City:FLOYD
Mailing Address - State:VA
Mailing Address - Zip Code:24091-0597
Mailing Address - Country:US
Mailing Address - Phone:540-745-6034
Mailing Address - Fax:540-745-6033
Practice Address - Street 1:274 FLOYD HWY S
Practice Address - Street 2:SUITE 102
Practice Address - City:FLOYD
Practice Address - State:VA
Practice Address - Zip Code:24091-2391
Practice Address - Country:US
Practice Address - Phone:540-745-6034
Practice Address - Fax:540-745-6033
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-06
Last Update Date:2008-06-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0102036909332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA009112421Medicaid
VA5271670001Medicare NSC