Provider Demographics
NPI:1538339718
Name:OSBORNE MOBILE DIAGNOSTIC SERVICES
Entity type:Organization
Organization Name:OSBORNE MOBILE DIAGNOSTIC SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:KENNETH
Authorized Official - Middle Name:EDWARD
Authorized Official - Last Name:LOCKHART
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:412-882-9729
Mailing Address - Street 1:3502 SHADEWELL AVE
Mailing Address - Street 2:
Mailing Address - City:BRENTWOOD
Mailing Address - State:PA
Mailing Address - Zip Code:15227-2926
Mailing Address - Country:US
Mailing Address - Phone:412-882-9729
Mailing Address - Fax:412-882-3441
Practice Address - Street 1:3502 SHADEWELL AVE
Practice Address - Street 2:
Practice Address - City:BRENTWOOD
Practice Address - State:PA
Practice Address - Zip Code:15227-2926
Practice Address - Country:US
Practice Address - Phone:412-882-9729
Practice Address - Fax:412-882-3441
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-03-04
Last Update Date:2008-03-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes335V00000XSuppliersPortable X-ray and/or Other Portable Diagnostic Imaging Supplier
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA303502Medicare PIN