Provider Demographics
NPI:1659346872
Name:SUSAN P. OSBORNE, DO
Entity Type:Organization
Organization Name:SUSAN P. OSBORNE, DO
Other - Org Name:THE BARTER CLINIC
Other - Org Type:Other Name
Authorized Official - Title/Position:MEDICAL DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:SUSAN
Authorized Official - Middle Name:PAGE
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:STE 102
Practice Address - City:FLOYD
Practice Address - State:VA
Practice Address - Zip Code:24091-2348
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:2006-02-21
Last Update Date:2010-03-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA09040021961041C0700X
VA0102036909207Q00000X
VA0110840358363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
No1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Multi-Specialty
No363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedicalGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA49D0951520OtherCLIA #
VAC08779Medicare ID - Type UnspecifiedGROUP ID#