Basic Information
| Provider Information | |||||||||
| NPI: | 1588716872 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | ASHLAND OSTEOPATHIC SERVICES, P.C. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 850 SISKIYOU BLVD | ||||||||
| Address2: | SUITE 7 | ||||||||
| City: | ASHLAND | ||||||||
| State: | OR | ||||||||
| PostalCode: | 975202125 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5414820342 | ||||||||
| FaxNumber: | 5414826986 | ||||||||
| Practice Location | |||||||||
| Address1: | 850 SISKIYOU BLVD | ||||||||
| Address2: | SUITE 7 | ||||||||
| City: | ASHLAND | ||||||||
| State: | OR | ||||||||
| PostalCode: | 975202125 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5414820342 | ||||||||
| FaxNumber: | 5414826986 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 01/17/2007 | ||||||||
| LastUpdateDate: | 08/22/2020 | ||||||||
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| AuthorizedOfficialLastName: | THOMAS | ||||||||
| AuthorizedOfficialFirstName: | MICHAEL | ||||||||
| AuthorizedOfficialMiddleName: | E | ||||||||
| AuthorizedOfficialTitleorPosition: | PRESIDENT | ||||||||
| AuthorizedOfficialTelephone: | 5414820342 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | MR. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 204D00000X | Y | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Neuromusculoskeletal Medicine & OMM |
No ID Information.