MEDICARE: OSVALDO ACOSTA-RODRIGUEZ MD

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	208100000X	Physical Medicine & Rehabilitation Physician	2003026609	MO

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	P00085648	OTHER		RR MEDICARE
7	CD9211	OTHER		RR MEDICARE

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier Issuer
2	0549741	OTHER	CIGNA
3	1178759	OTHER	FIRST HEALTH
4	G17884	OTHER	MERCY
5	187895	OTHER	BLUE CROSS BLUE SHIELD
6	627300	OTHER	HEALTHLINK

General Provider Information

NPI Number	:	1558334524
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	OSVALDO ACOSTA-RODRIGUEZ MD

Provider Business Mailing Address
First Line	:	1500 SOUTHWEST BLVD
Second Line	:	STE C CAPITAL REGION CORPORATE HEALTH CLINIC
City	:	JEFFERSON CITY
State	:	MO
Zip	:	65109
Country	:	US
Telephone Number	:	573-632-5786
Fax Number	:	573-632-5833

Provider Business Practice Location Address
First Line	:	1500 SOUTHWEST BLVD
Second Line	:	STE C
City	:	JEFFERSON CITY
State	:	MO
Zip	:	65109
Country	:	US
Telephone Number	:	573-632-5786
Fax Number	:	573-632-5833

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	02/09/2006
Last Update Date	:	07/08/2007

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