Basic Information
| Provider Information | |||||||||
| NPI: | 1255413522 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | OSBORNE | ||||||||
| FirstName: | THOMAS | ||||||||
| MiddleName: | E | ||||||||
| NamePrefix: | DR. | ||||||||
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| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 115 10TH AVE NE | ||||||||
| Address2: | ESSENTIA HEALTH DEER RIVER | ||||||||
| City: | DEER RIVER | ||||||||
| State: | MN | ||||||||
| PostalCode: | 566368795 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2182462900 | ||||||||
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| Practice Location | |||||||||
| Address1: | 115 10TH AVE NE | ||||||||
| Address2: | ESSENTIA HEALTH DEER RIVER | ||||||||
| City: | DEER RIVER | ||||||||
| State: | MN | ||||||||
| PostalCode: | 566368795 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2182462900 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 10/19/2006 | ||||||||
| LastUpdateDate: | 11/27/2015 | ||||||||
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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 | 207Q00000X | 40784 | MN | Y | Allopathic & Osteopathic Physicians | Family Medicine |
ID Information
| ID | Type | State | Issuer | Description | 20F80OS | 01 | MN | BLUES & FIRST PLAN | OTHER | 0105003 | 01 | MN | MEDICA | OTHER | 793326600 | 05 | MN | MEDICAID |