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NPI Code Detail

MEDICARE: CASEY A OSBORNE-RODHOUSE PA

MEDICARE: CASEY A OSBORNE-RODHOUSE PA
Medicare Provider Information

Scope of Practice

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

# Taxonomy Code Taxonomy License Number License Number State
1363A00000XPhysician AssistantPA00855OR

Medicare Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
200850179OTHERORMEDICARE RAILROAD

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1619067378
Entity Type Code : Individual
Provider Name (Legal Business Name) : CASEY A OSBORNE-RODHOUSE PA
Provider Business Mailing Address
First Line : PO BOX 4228
Second Line :
City : PORTLAND
State : OR
Zip : 97208-4228
Country : US
Telephone Number : 541-383-3005
Fax Number : 541-383-1883
Provider Business Practice Location Address
First Line : 2577 NE COURTNEY DR STE 100
Second Line :
City : BEND
State : OR
Zip : 97701-7752
Country : US
Telephone Number : 541-383-3005
Fax Number : 541-383-1883
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 10/13/2006
Last Update Date : 10/07/2024

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Directions to “ CASEY A OSBORNE-RODHOUSE PA” Practice Location

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