Provider Demographics
NPI:1194977165
Name:STEVEN R OSA MD PC
Entity type:Organization
Organization Name:STEVEN R OSA MD PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:LIESBETH
Authorized Official - Middle Name:
Authorized Official - Last Name:OSA
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:303-722-4683
Mailing Address - Street 1:850 E HARVARD AVE
Mailing Address - Street 2:# 405
Mailing Address - City:DENVER
Mailing Address - State:CO
Mailing Address - Zip Code:80210-5073
Mailing Address - Country:US
Mailing Address - Phone:303-722-4683
Mailing Address - Fax:303-778-0726
Practice Address - Street 1:850 E HARVARD AVE
Practice Address - Street 2:# 405
Practice Address - City:DENVER
Practice Address - State:CO
Practice Address - Zip Code:80210-5073
Practice Address - Country:US
Practice Address - Phone:303-722-4683
Practice Address - Fax:303-778-0726
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-10-21
Last Update Date:2008-10-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO24523174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO04008546Medicaid
CO04008546Medicaid