MEDICARE: MR. CARROLL EVERETT ROSE MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	208600000X	Surgery Physician	7511	TN

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1407857352
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. CARROLL EVERETT ROSE MD

Provider Business Mailing Address
First Line	:	PO BOX 1679
Second Line	:
City	:	NEW TAZEWELL
State	:	TN
Zip	:	37825-1679
Country	:	US
Telephone Number	:	423-626-4288
Fax Number	:	423-626-1101

Provider Business Practice Location Address
First Line	:	1610 TAZEWELL RD
Second Line	:	STE 301
City	:	TAZEWELL
State	:	TN
Zip	:	37879-3600
Country	:	US
Telephone Number	:	423-626-4288
Fax Number	:	423-626-1101

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/02/2005
Last Update Date	:	01/02/2013

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