1407176878 NPI number — DR OSH AND ASSOCIATES FOOT AND LEG CLINIC, PC

Table of content: (NPI 1407176878)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1407176878 NPI number — DR OSH AND ASSOCIATES FOOT AND LEG CLINIC, PC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
DR OSH AND ASSOCIATES FOOT AND LEG CLINIC, PC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1407176878
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
06/08/2010
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
105 WEXFORD CIR
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
BONAIRE
Provider Business Mailing Address State Name:
GA
Provider Business Mailing Address Postal Code:
31005-4734
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
478-328-6466
Provider Business Mailing Address Fax Number:
478-328-1338

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1030 PEACH PKWY STE 1
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
FORT VALLEY
Provider Business Practice Location Address State Name:
GA
Provider Business Practice Location Address Postal Code:
31030-8191
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
478-822-9088
Provider Business Practice Location Address Fax Number:
478-822-1177
Provider Enumeration Date:
06/08/2010

Additional Information

Authorized Official

Authorized Official Last Name:
OSHIOKPEKHAI
Authorized Official First Name:
EVARISTUS
Authorized Official Middle Name:
I
Authorized Official Title or Position:
PRESIDENT/CEO
Authorized Official Telephone Number:
478-328-6466

Provider Taxonomy Codes

  • Taxonomy code: 213E00000X , with the licence number:  POD001117 , registered in the state of GA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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