Provider Demographics
NPI:1356308670
Name:OSLER MEDICAL INC
Entity type:Organization
Organization Name:OSLER MEDICAL INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIEF ADMINISTRATIVE OFFICE
Authorized Official - Prefix:
Authorized Official - First Name:BRENDA
Authorized Official - Middle Name:KAY
Authorized Official - Last Name:MERCHBERGER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:321-725-5050
Mailing Address - Street 1:930 S HARBOR CITY BLVD
Mailing Address - Street 2:
Mailing Address - City:MELBOURNE
Mailing Address - State:FL
Mailing Address - Zip Code:32901
Mailing Address - Country:US
Mailing Address - Phone:321-725-5050
Mailing Address - Fax:321-725-9100
Practice Address - Street 1:930 S HARBOR CITY BLVD
Practice Address - Street 2:
Practice Address - City:MELBOURNE
Practice Address - State:FL
Practice Address - Zip Code:32901
Practice Address - Country:US
Practice Address - Phone:321-725-5050
Practice Address - Fax:321-725-9100
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-04-28
Last Update Date:2009-02-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM1300XAmbulatory Health Care FacilitiesClinic/CenterMulti-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL0884270001OtherDMEPOS
FLCC0819OtherRR MEDICARE
FL256740700Medicaid
FL40589Medicare ID - Type UnspecifiedGROUP ID
FL256740700Medicaid