MEDICARE: JEFFREY R OSWORTH PA

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	363AM0700X	Medical Physician Assistant	50001098	OH
2	363AM0700X	Medical Physician Assistant	5601002855	MI

General Provider Information

NPI Number	:	1861490831
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JEFFREY R OSWORTH PA

Provider Business Mailing Address
First Line	:	1500 GADY RD
Second Line	:
City	:	ADRIAN
State	:	MI
Zip	:	49221-9807
Country	:	US
Telephone Number	:	517-264-1922
Fax Number	:	517-263-6456

Provider Business Practice Location Address
First Line	:	770 RIVERSIDE AVE
Second Line	:	SUITE 207
City	:	ADRIAN
State	:	MI
Zip	:	49221-1476
Country	:	US
Telephone Number	:	517-264-1922
Fax Number	:	517-263-6456

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

Provider Enumeration Date	:	07/13/2005
Last Update Date	:	04/29/2008

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Directions to “ JEFFREY R OSWORTH PA” Practice Location

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