Healthcare Provider Details

I. General information

NPI: 1902006844
Provider Name (Legal Business Name): JAY R. OSBORNE, MD, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/19/2007
Last Update Date: 07/19/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10850 MAHONING AVE.
NORTH JACKSON OH
44451
US

IV. Provider business mailing address

10850 MAHONING AVE. P.O. BOX 487
NORTH JACKSON OH
44451
US

V. Phone/Fax

Practice location:
  • Phone: 330-538-2490
  • Fax: 330-538-2575
Mailing address:
  • Phone: 330-538-2490
  • Fax: 330-538-2575

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number StateOH

VIII. Authorized Official

Name: SUSAN OSBORNE
Title or Position: MANAGER
Credential:
Phone: 330-538-2490