Healthcare Provider Details

I. General information

NPI: 1760585178
Provider Name (Legal Business Name): ROSE CANCER CENTER PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/07/2006
Last Update Date: 12/06/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

807 ROBB STREET
SUMMIT MS
39666
US

IV. Provider business mailing address

PO BOX 1963
MCCOMB MS
39649
US

V. Phone/Fax

Practice location:
  • Phone: 601-957-7340
  • Fax: 601-249-5529
Mailing address:
  • Phone: 601-249-5526
  • Fax: 601-249-5529

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RH0003X
TaxonomyHematology & Oncology Physician
License Number18057
License Number StateMS

VIII. Authorized Official

Name: MEERA SACHDEVA
Title or Position: PHYSICIAN MEDICAL DIRECTOR
Credential: MD
Phone: 601-249-5526