MEDICARE: ONSLOW MEDICAL SPECIALTIES CLINIC, PC

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
1	173F00000X	Sleep Specialist (PhD)
2	207RP1001X	Pulmonary Disease Physician

General Provider Information

NPI Number	:	1982958195
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ONSLOW MEDICAL SPECIALTIES CLINIC, PC

Provider Business Mailing Address
First Line	:	123 POMPANO PLACE
Second Line	:	SUITE 100
City	:	JACKSONVILLE
State	:	NC
Zip	:	28546-5293
Country	:	US
Telephone Number	:	910-455-9398
Fax Number	:	910-455-5407

Provider Business Practice Location Address
First Line	:	123 POMPANO PLACE
Second Line	:	SUITE 100
City	:	JACKSONVILLE
State	:	NC
Zip	:	28546-5293
Country	:	US
Telephone Number	:	910-455-9398
Fax Number	:	910-455-5407

Authorized Official
Title or Position	:	PRESIDENT/CEO/MEDICAL DIRECTOR
Name	:	DR. EUSEBIO C DESUYO
Credential	:	MD
Telephone Number	:	910-467-9419

Provider Enumeration Date	:	11/09/2012
Last Update Date	:	12/18/2023

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