Healthcare Provider Details

I. General information

NPI: 1639561244
Provider Name (Legal Business Name): ROSEMORE PRIMARY CARE & REHAB SERVICES LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/19/2015
Last Update Date: 05/22/2020
Certification Date: 05/22/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3800 RIDGEWAY DR
BIRMINGHAM AL
35209-5506
US

IV. Provider business mailing address

PO BOX 2391
BIRMINGHAM AL
35201-2391
US

V. Phone/Fax

Practice location:
  • Phone: 205-868-2000
  • Fax:
Mailing address:
  • Phone: 205-999-1016
  • Fax: 205-874-9197

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberDO159
License Number StateAL
# 2
Primary TaxonomyN
Taxonomy Code208100000X
TaxonomyPhysical Medicine & Rehabilitation Physician
License Number
License Number State

VIII. Authorized Official

Name: MICHAEL A ROSEMORE
Title or Position: PRESIDENT
Credential: DO
Phone: 205-514-1122