Provider Demographics
NPI:1215138508
Name:OSBORNE ORTHOPEDIC GROUP INC.
Entity type:Organization
Organization Name:OSBORNE ORTHOPEDIC GROUP INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:TOMMY
Authorized Official - Middle Name:TAYLOR
Authorized Official - Last Name:OSBORNE
Authorized Official - Suffix:II
Authorized Official - Credentials:MD
Authorized Official - Phone:757-777-4110
Mailing Address - Street 1:1701 CHURCH ST STE A
Mailing Address - Street 2:
Mailing Address - City:NORFOLK
Mailing Address - State:VA
Mailing Address - Zip Code:23504-2304
Mailing Address - Country:US
Mailing Address - Phone:757-548-7190
Mailing Address - Fax:757-548-7191
Practice Address - Street 1:1701 CHURCH ST STE A
Practice Address - Street 2:
Practice Address - City:NORFOLK
Practice Address - State:VA
Practice Address - Zip Code:23504-2304
Practice Address - Country:US
Practice Address - Phone:757-548-7190
Practice Address - Fax:757-548-7191
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-31
Last Update Date:2021-11-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101050384174400000X, 207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryGroup - Multi-Specialty
No174400000XOther Service ProvidersSpecialistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA6402950Medicaid
VA10255350Medicaid
VA006402958Medicaid
VA1598768103Medicaid
362091900OtherOWCP
VAC08495Medicare ID - Type Unspecified
VA6402950Medicaid