Healthcare Provider Details

I. General information

NPI: 1295176824
Provider Name (Legal Business Name): ROSE IMAGING SPECIALISTS, PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/11/2013
Last Update Date: 07/12/2024
Certification Date: 07/12/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1250 8TH AVE STE 130
FT WORTH TX
76104-4156
US

IV. Provider business mailing address

PO BOX 203268
DALLAS TX
75320-3053
US

V. Phone/Fax

Practice location:
  • Phone: 817-886-0880
  • Fax:
Mailing address:
  • Phone: 866-613-5807
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code2085R0204X
TaxonomyVascular & Interventional Radiology Physician
License Number
License Number State

VIII. Authorized Official

Name: SHARLEE LEBLEU
Title or Position: VICE PRESIDENT
Credential:
Phone: 480-321-7026