Provider Demographics
NPI:1174768287
Name:VAN OSTEN, GEORGE KARL III (MD)
Entity type:Individual
Prefix:DR
First Name:GEORGE
Middle Name:KARL
Last Name:VAN OSTEN
Suffix:III
Gender:
Credentials:MD
Other - Prefix:
Other - First Name:G
Other - Middle Name:KARL
Other - Last Name:VAN OSTEN
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:4381 SOUTH EASON BLVD., SUITE 303
Mailing Address - Street 2:NORTH MISSISSIPPI SPORTS MEDICINE AND ORTHOPAEDIC CLINI
Mailing Address - City:TUPELO
Mailing Address - State:MS
Mailing Address - Zip Code:38801
Mailing Address - Country:US
Mailing Address - Phone:662-840-5747
Mailing Address - Fax:662-840-5856
Practice Address - Street 1:4381 SOUTH EASON BLVD., SUITE 303
Practice Address - Street 2:NORTH MISSISSIPPI SPORTS MEDICINE AND ORTHOPAEDIC CLINI
Practice Address - City:TUPELO
Practice Address - State:MS
Practice Address - Zip Code:38801
Practice Address - Country:US
Practice Address - Phone:662-840-5747
Practice Address - Fax:662-840-5856
Is Sole Proprietor?:No
Enumeration Date:2008-12-04
Last Update Date:2025-04-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS20792207X00000X
WI4944-320207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
302I200358Medicare UPIN