Provider Demographics
NPI:1881272664
Name:THE OSTERBAUER CLINIC LLC
Entity type:Organization
Organization Name:THE OSTERBAUER CLINIC LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:PETER
Authorized Official - Middle Name:JOHN
Authorized Official - Last Name:OSTERBAUER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:907-531-1840
Mailing Address - Street 1:PO BOX 770165
Mailing Address - Street 2:
Mailing Address - City:EAGLE RIVER
Mailing Address - State:AK
Mailing Address - Zip Code:99577-0165
Mailing Address - Country:US
Mailing Address - Phone:907-531-1840
Mailing Address - Fax:907-802-6617
Practice Address - Street 1:10928 EAGLE RIVER RD STE 129
Practice Address - Street 2:
Practice Address - City:EAGLE RIVER
Practice Address - State:AK
Practice Address - Zip Code:99577-8078
Practice Address - Country:US
Practice Address - Phone:907-531-1840
Practice Address - Fax:907-531-1835
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-04-01
Last Update Date:2024-01-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
1831115955OtherPROVIDER NPI