Provider Demographics
NPI:1598366049
Name:OSWALD DIGESTIVE CLINIC LLC
Entity Type:Organization
Organization Name:OSWALD DIGESTIVE CLINIC LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIETITIAN & FOUNDER
Authorized Official - Prefix:
Authorized Official - First Name:ASHLEY
Authorized Official - Middle Name:
Authorized Official - Last Name:OSWALD
Authorized Official - Suffix:
Authorized Official - Credentials:RDN
Authorized Official - Phone:612-805-7142
Mailing Address - Street 1:2893 KNOX AVE S APT 607
Mailing Address - Street 2:
Mailing Address - City:MINNEAPOLIS
Mailing Address - State:MN
Mailing Address - Zip Code:55408-1865
Mailing Address - Country:US
Mailing Address - Phone:612-805-7142
Mailing Address - Fax:
Practice Address - Street 1:2893 KNOX AVE S APT 607
Practice Address - Street 2:
Practice Address - City:MINNEAPOLIS
Practice Address - State:MN
Practice Address - Zip Code:55408-1865
Practice Address - Country:US
Practice Address - Phone:612-805-7142
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-11-02
Last Update Date:2020-11-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center
No133N00000XDietary & Nutritional Service ProvidersNutritionistGroup - Multi-Specialty
No133V00000XDietary & Nutritional Service ProvidersDietitian, RegisteredGroup - Multi-Specialty
No261QC1500XAmbulatory Health Care FacilitiesClinic/CenterCommunity Health