Provider Demographics
NPI:1497816011
Name:ORTHOPAEDIC TRAUMA SOLUTIONS INC
Entity Type:Organization
Organization Name:ORTHOPAEDIC TRAUMA SOLUTIONS INC
Other - Org Name:AARON G OSBORNE DO INC
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:LISA
Authorized Official - Middle Name:R
Authorized Official - Last Name:VANDEBURG
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:530-242-1266
Mailing Address - Street 1:2662 EDITH AVE
Mailing Address - Street 2:
Mailing Address - City:REDDING
Mailing Address - State:CA
Mailing Address - Zip Code:96001
Mailing Address - Country:US
Mailing Address - Phone:530-242-1266
Mailing Address - Fax:530-243-4205
Practice Address - Street 1:2662 EDITH AVE
Practice Address - Street 2:
Practice Address - City:REDDING
Practice Address - State:CA
Practice Address - Zip Code:96001
Practice Address - Country:US
Practice Address - Phone:530-242-1266
Practice Address - Fax:530-243-4205
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-13
Last Update Date:2014-04-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA20A9141174400000X, 207XX0801X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207XX0801XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryOrthopaedic TraumaGroup - Multi-Specialty
No174400000XOther Service ProvidersSpecialistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00AX91410Medicaid
CAZZZ03999ZMedicare PIN
CA00AX91410Medicaid