Provider Demographics
NPI: | 1013161314 |
---|---|
Name: | OSLER MEDICAL INC |
Entity Type: | Organization |
Organization Name: | OSLER MEDICAL INC |
Other - Org Name: | CRANE CREEK MEDICAL CENTER |
Other - Org Type: | Doing Business As |
Authorized Official - Title/Position: | CREDENTIALING COORDINATOR |
Authorized Official - Prefix: | |
Authorized Official - First Name: | LAURIE |
Authorized Official - Middle Name: | D |
Authorized Official - Last Name: | BRITT |
Authorized Official - Suffix: | |
Authorized Official - Credentials: | |
Authorized Official - Phone: | 321-725-5050 |
Mailing Address - Street 1: | 930 S HARBOR CITY BLVD |
Mailing Address - Street 2: | |
Mailing Address - City: | MELBOURNE |
Mailing Address - State: | FL |
Mailing Address - Zip Code: | 32901-1963 |
Mailing Address - Country: | US |
Mailing Address - Phone: | 321-725-5050 |
Mailing Address - Fax: | 321-725-9100 |
Practice Address - Street 1: | 2222 S HARBOR CITY BLVD |
Practice Address - Street 2: | |
Practice Address - City: | MELBOURNE |
Practice Address - State: | FL |
Practice Address - Zip Code: | 32901-5527 |
Practice Address - Country: | US |
Practice Address - Phone: | 321-725-5050 |
Practice Address - Fax: | 321-725-9100 |
EIN: | <UNAVAIL> |
Is Organization Subpart?: | No |
Parent Organization LBN: | |
Parent Organization TIN: | |
Enumeration Date: | 2008-11-13 |
Last Update Date: | 2008-11-13 |
Deactivation Date: | |
Deactivation Code: | |
Reactivation Date: |
Provider Taxonomies
Primary? | Code | Type | Classification | Specialization | Group |
---|---|---|---|---|---|
Yes | 207R00000X | Allopathic & Osteopathic Physicians | Internal Medicine | Group - Multi-Specialty | |
No | 207RG0100X | Allopathic & Osteopathic Physicians | Internal Medicine | Gastroenterology | Group - Multi-Specialty |
No | 207RH0003X | Allopathic & Osteopathic Physicians | Internal Medicine | Hematology & Oncology | Group - Multi-Specialty |
No | 207RR0500X | Allopathic & Osteopathic Physicians | Internal Medicine | Rheumatology | Group - Multi-Specialty |
No | 207T00000X | Allopathic & Osteopathic Physicians | Neurological Surgery | Group - Multi-Specialty | |
No | 207X00000X | Allopathic & Osteopathic Physicians | Orthopaedic Surgery | Group - Multi-Specialty | |
No | 207XS0117X | Allopathic & Osteopathic Physicians | Orthopaedic Surgery | Orthopaedic Surgery of the Spine | Group - Multi-Specialty |
No | 207XX0004X | Allopathic & Osteopathic Physicians | Orthopaedic Surgery | Foot and Ankle Surgery | Group - Multi-Specialty |
No | 208100000X | Allopathic & Osteopathic Physicians | Physical Medicine & Rehabilitation | Group - Multi-Specialty | |
No | 2084N0400X | Allopathic & Osteopathic Physicians | Psychiatry & Neurology | Neurology | Group - Multi-Specialty |
No | 208600000X | Allopathic & Osteopathic Physicians | Surgery | Group - Multi-Specialty | |
No | 2086S0129X | Allopathic & Osteopathic Physicians | Surgery | Vascular Surgery | Group - Multi-Specialty |
No | 208VP0000X | Allopathic & Osteopathic Physicians | Pain Medicine | Pain Medicine | Group - Multi-Specialty |
No | 208VP0014X | Allopathic & Osteopathic Physicians | Pain Medicine | Interventional Pain Medicine | Group - Multi-Specialty |
Provider Identifiers
State | Identifier ID | ID Type | Issuer |
---|---|---|---|
FL | 40589 | Medicare PIN |