Basic Information
| Provider Information | |||||||||
| NPI: | 1174768287 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | VAN OSTEN | ||||||||
| FirstName: | GEORGE | ||||||||
| MiddleName: | KARL | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | III | ||||||||
| Credential: | MD | ||||||||
| OtherOrganizationName: | |||||||||
| OtherOrganizationType: | |||||||||
| OtherLastName: | VAN OSTEN | ||||||||
| OtherFirstName: | G | ||||||||
| OtherMiddleName: | KARL | ||||||||
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| OtherCredential: | M.D. | ||||||||
| OtherLastNameType: | 5 | ||||||||
| Mailing Information | |||||||||
| Address1: | 4381 SOUTH EASON BLVD., SUITE 303 | ||||||||
| Address2: | NORTH MISSISSIPPI SPORTS MEDICINE AND ORTHOPAEDIC CLINI | ||||||||
| City: | TUPELO | ||||||||
| State: | MS | ||||||||
| PostalCode: | 38801 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6628405747 | ||||||||
| FaxNumber: | 6628405856 | ||||||||
| Practice Location | |||||||||
| Address1: | 4381 SOUTH EASON BLVD., SUITE 303 | ||||||||
| Address2: | NORTH MISSISSIPPI SPORTS MEDICINE AND ORTHOPAEDIC CLINI | ||||||||
| City: | TUPELO | ||||||||
| State: | MS | ||||||||
| PostalCode: | 38801 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6628405747 | ||||||||
| FaxNumber: | 6628405856 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 12/04/2008 | ||||||||
| LastUpdateDate: | 04/21/2011 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207X00000X | 20792 | MS | Y | Allopathic & Osteopathic Physicians | Orthopaedic Surgery |
No ID Information.