MEDICARE: OSNA PLLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy
1	207XS0106X	Orthopaedic Hand Surgery Physician
2	208100000X	Physical Medicine & Rehabilitation Physician
3	207X00000X	Orthopaedic Surgery Physician

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
2	DQ4501	OTHER	AZ	RAILROAD MEDICARE PTAN

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	6419820020	OTHER		NSC

General Provider Information

NPI Number	:	1255741500
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	OSNA PLLC

Provider Business Mailing Address
First Line	:	PO BOX 271429
Second Line	:
City	:	SALT LAKE CITY
State	:	UT
Zip	:	84127-1429
Country	:	US
Telephone Number	:	602-772-3800
Fax Number	:	602-772-3801

Provider Business Practice Location Address
First Line	:	21231 E. OCOTILLO RD.
Second Line	:	SUITE 134
City	:	QUEEN CREEK
State	:	AZ
Zip	:	85142-5995
Country	:	US
Telephone Number	:	480-924-1552
Fax Number	:	480-830-8417

Authorized Official
Title or Position	:	CREDENTIALING AUTHORITY
Name	:	MELISSA A ENGLERT
Credential	:
Telephone Number	:	602-385-2115

Provider Enumeration Date	:	05/07/2014
Last Update Date	:	02/14/2018

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Directions to “OSNA PLLC ” Practice Location

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