Healthcare Provider Details

I. General information

NPI: 1891741914
Provider Name (Legal Business Name): DRS ROSE & THOMAS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/26/2006
Last Update Date: 04/16/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1610 TAZEWELL RD STE 301
TAZEWELL TN
37879-3600
US

IV. Provider business mailing address

PO BOX 1679
NEW TAZEWELL TN
37825-1679
US

V. Phone/Fax

Practice location:
  • Phone: 423-626-4288
  • Fax: 423-626-1101
Mailing address:
  • Phone: 423-626-4288
  • Fax: 423-626-1101

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number12835
License Number StateTN
# 2
Primary TaxonomyY
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number7511
License Number StateTN

VIII. Authorized Official

Name: MRS. JANICE MARIE ROSE
Title or Position: OFFICE MGR
Credential:
Phone: 423-626-4288