Basic Information
| Provider Information | |||||||||
| NPI: | 1356308670 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | OSLER MEDICAL INC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 930 S HARBOR CITY BLVD | ||||||||
| Address2: | |||||||||
| City: | MELBOURNE | ||||||||
| State: | FL | ||||||||
| PostalCode: | 32901 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3217255050 | ||||||||
| FaxNumber: | 3217259100 | ||||||||
| Practice Location | |||||||||
| Address1: | 930 S HARBOR CITY BLVD | ||||||||
| Address2: | |||||||||
| City: | MELBOURNE | ||||||||
| State: | FL | ||||||||
| PostalCode: | 32901 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3217255050 | ||||||||
| FaxNumber: | 3217259100 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 04/28/2006 | ||||||||
| LastUpdateDate: | 02/06/2009 | ||||||||
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| AuthorizedOfficialLastName: | MERCHBERGER | ||||||||
| AuthorizedOfficialFirstName: | BRENDA | ||||||||
| AuthorizedOfficialMiddleName: | KAY | ||||||||
| AuthorizedOfficialTitleorPosition: | CHIEF ADMINISTRATIVE OFFICE | ||||||||
| AuthorizedOfficialTelephone: | 3217255050 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 261QM1300X | Y | Ambulatory Health Care Facilities | Clinic/Center | Multi-Specialty |
ID Information
| ID | Type | State | Issuer | Description | 0884270001 | 01 | FL | DMEPOS | OTHER | CC0819 | 01 | FL | RR MEDICARE | OTHER | 256740700 | 05 | FL | MEDICAID |