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General NPI Number Information
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NPI Number | 1114399011
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Entity Type | Organization
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Legal Business Name | BETSY A ROSE
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Dates
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Enumeration Date | 10/30/2015
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Last Update Date | 12/15/2015
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Provider Practice Location Address
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Address Line | 725 COMMONWEALTH AVE
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City | BRISTOL
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State | VA
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Zip | 24201-3321
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Country | US
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Telephone | 276-466-8119
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Fax |
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Provider Business Mailing Address
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Address Line | 725 COMMONWEALTH AVE
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City | BRISTOL
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State | VA
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Zip | 24201-3321
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Country | US
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Telephone | 276-466-8119
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | BETSY A ROSE
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Credential |
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Telephone | 276-466-8119
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 332B00000X
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Taxonomy Name | Durable Medical Equipment & Medical Supplies
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License Number | 1101001369
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License Number State | VA
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