Active NPI
Tom Osborn
- Contractor
- Black Eagle, MT
National Provider Identifier
1043680994
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Contractor
- License
- 193766
- Practice address
- 1120 25TH Ave
Black Eagle, MT 59414-1037 - Phone
- (406) 452-9834
- Fax
- (406) 453-3940
- NPI assigned
- Oct 5, 2015
- Last updated
- Oct 5, 2015
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Contractor | 171W00000X | 193766 | MT | Primary |
Addresses
Primary practice location
1120 25TH Ave
Black Eagle, MT 59414-1037
Mailing address
1120 25TH Ave
Black Eagle, MT 59414-1037
Phone (406) 452-9834
Other identifiers 2
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 193766 | Medicaid | MT | |
| 136084 | Medicaid | MT |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 193766 | MT | MD | Contractor |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| North Central Independent Living Services,Inc | Current | Accepting new patients |
Locations
1120 25th Ave
Black Eagle, MT 59414
Phone (406) 452-9834
Organizations & group practices 1
Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.
-
- In Home Supportive Care Agency
- Black Eagle, MT
- NPI 1518337286
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1444003200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1444003200000",
"number": "1043680994",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1120 25TH AVE",
"city": "BLACK EAGLE",
"state": "MT",
"postal_code": "594141037",
"telephone_number": "406-452-9834",
"fax_number": "406-453-3940"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1120 25TH AVE",
"city": "BLACK EAGLE",
"state": "MT",
"postal_code": "594141037",
"telephone_number": "406-452-9834",
"fax_number": "406-453-3940"
}
],
"practiceLocations": [],
"basic": {
"last_name": "OSBORN",
"first_name": "TOM",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2015-10-05",
"last_updated": "2015-10-05",
"status": "A"
},
"taxonomies": [
{
"code": "171W00000X",
"taxonomy_group": "",
"desc": "Contractor",
"state": "MT",
"license": "193766",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "193766",
"state": "MT"
},
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "136084",
"state": "MT"
}
],
"endpoints": [],
"other_names": []
}Other providers in Black Eagle, MT
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 5, 2015; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.