Healthcare Provider Details

I. General information

NPI: 1659698942
Provider Name (Legal Business Name): SCOTT NEILL OSBORNE M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/26/2010
Last Update Date: 08/25/2025
Certification Date: 08/25/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1720 E REELFOOT AVE STE 200
UNION CITY TN
38261-6049
US

IV. Provider business mailing address

1720 E REELFOOT AVE STE 200
UNION CITY TN
38261-6049
US

V. Phone/Fax

Practice location:
  • Phone: 901-350-0978
  • Fax:
Mailing address:
  • Phone: 901-350-0978
  • Fax: 901-350-0677

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License Number301659
License Number StateLA
# 2
Primary TaxonomyN
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License Number49849
License Number StateTN
# 3
Primary TaxonomyN
Taxonomy Code2085R0204X
TaxonomyVascular & Interventional Radiology Physician
License Number26811
License Number StateMS
# 4
Primary TaxonomyN
Taxonomy Code208VP0014X
TaxonomyInterventional Pain Medicine Physician
License Number49849
License Number StateTN
# 5
Primary TaxonomyY
Taxonomy Code2085R0204X
TaxonomyVascular & Interventional Radiology Physician
License Number0000049849
License Number StateTN

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: