MEDICARE: ROBERT N OSDYKE, 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	335E00000X	Prosthetic/Orthotic Supplier	000427	MO

General Provider Information

NPI Number	:	1629257399
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ROBERT N OSDYKE, INC

Provider Business Mailing Address
First Line	:	15421 CLAYTON RD
Second Line	:
City	:	BALLWIN
State	:	MO
Zip	:	63011-3161
Country	:	US
Telephone Number	:	636-207-0444
Fax Number	:	636-207-0446

Provider Business Practice Location Address
First Line	:	15421 CLAYTON RD
Second Line	:
City	:	BALLWIN
State	:	MO
Zip	:	63011-3161
Country	:	US
Telephone Number	:	636-207-0444
Fax Number	:	636-207-0446

Authorized Official
Title or Position	:	OWNER
Name	:	DR. ROBERT N OSDYKE
Credential	:	DPM
Telephone Number	:	636-207-0444

Provider Enumeration Date	:	10/30/2007
Last Update Date	:	06/07/2010

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