Healthcare Provider Details

I. General information

NPI: 1114133055
Provider Name (Legal Business Name): DRS ROSE AND THOMAS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/15/2007
Last Update Date: 04/19/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

123 N 19TH ST
MIDDLESBORO KY
40965
US

IV. Provider business mailing address

PO BOX 1679
NEW TAZEWELL TN
37825-1679
US

V. Phone/Fax

Practice location:
  • Phone: 606-248-7509
  • Fax: 606-248-5917
Mailing address:
  • Phone: 423-626-4288
  • Fax: 423-626-1101

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number
License Number StateKY

VIII. Authorized Official

Name: MRS. SHARON DAWN HAROLD
Title or Position: LPN OFFICE MANAGER
Credential: LPN OFFICE MANAGER
Phone: 606-248-7509