MEDICARE: OSBORNE ORTHOPEDIC GROUP, INC

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	332900000X	Non-Pharmacy Dispensing Site	0213001933	VA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	362091900	OTHER		OWCP
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1013300128
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	OSBORNE ORTHOPEDIC GROUP, INC

Provider Business Mailing Address
First Line	:	1701 CHURCH ST STE A
Second Line	:
City	:	NORFOLK
State	:	VA
Zip	:	23504-2304
Country	:	US
Telephone Number	:	757-548-7190
Fax Number	:	757-548-7190

Provider Business Practice Location Address
First Line	:	1701 CHURCH ST STE A
Second Line	:
City	:	NORFOLK
State	:	VA
Zip	:	23504-2304
Country	:	US
Telephone Number	:	757-548-7190
Fax Number	:	757-548-7190

Authorized Official
Title or Position	:	PRESIDENT/CEO
Name	:	DR. TOMMY TAYLOR OSBORNE II
Credential	:	MD
Telephone Number	:	757-777-4110

Provider Enumeration Date	:	03/13/2015
Last Update Date	:	11/20/2021

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