1366882201 NPI number — MS. MELINDA FRANCES OSBURN N.P.

Table of content: MS. MELINDA FRANCES OSBURN N.P. (NPI 1366882201)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1366882201 NPI number — MS. MELINDA FRANCES OSBURN N.P.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
OSBURN
Provider First Name:
MELINDA
Provider Middle Name:
FRANCES
Provider Name Prefix Text:
MS.
Provider Name Suffix Text:
Provider Credential Text:
N.P.
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
MAMEROW
Provider Other First Name:
MELINDA
Provider Other Middle Name:
FRANCES
Provider Other Name Prefix Text:
MS.
Provider Other Name Suffix Text:
Provider Other Credential Text:
N.P.
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1366882201
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/10/2013
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
696 JENTRY RD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
INEZ
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
77968-3342
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
979-541-6457
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2700 CITIZENS PLZ
Provider Second Line Business Practice Location Address:
SUITE 100
Provider Business Practice Location Address City Name:
VICTORIA
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
77901-5754
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
361-579-1371
Provider Business Practice Location Address Fax Number:
361-579-1373
Provider Enumeration Date:
06/25/2013

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 363LF0000X , with the licence number:  716851 , registered in the state of TX ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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