MEDICARE: STACY CLARENCE OSBORNE DPM

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	213E00000X	Podiatrist	36002140	OH

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	480002256	OTHER	OH	RAILROAD MEDICARE

Other Identifiers

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

General Provider Information

NPI Number	:	1861495442
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	STACY CLARENCE OSBORNE DPM

Provider Business Mailing Address
First Line	:	5521 MONTGOMERY RD
Second Line	:
City	:	NORWOOD
State	:	OH
Zip	:	45212-1848
Country	:	US
Telephone Number	:	513-351-6300
Fax Number	:

Provider Business Practice Location Address
First Line	:	5521 MONTGOMERY RD
Second Line	:
City	:	NORWOOD
State	:	OH
Zip	:	45212-1848
Country	:	US
Telephone Number	:	513-351-6300
Fax Number	:

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

Provider Enumeration Date	:	05/27/2005
Last Update Date	:	05/17/2019

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