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General NPI Number Information
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NPI Number | 1215063334
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Entity Type | Organization
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Legal Business Name | ROSE FAMILY CLINIC
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Dates
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Enumeration Date | 02/25/2007
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Last Update Date | 08/08/2022
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Provider Practice Location Address
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Address Line | 12124 HIGHWAY 52 W STE 5
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City | WESTMORELAND
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State | TN
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Zip | 37186-3257
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Country | US
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Telephone | 615-644-3000
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Fax | 615-644-3076
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Provider Business Mailing Address
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Address Line | 100B MALLARD SUNRISE DR E
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City | WESTMORELAND
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State | TN
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Zip | 37186-3251
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Country | US
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Telephone | 615-644-3000
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Fax | 615-644-3076
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Authorized Official
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Title or Position | SUPERVISING PHYSICIAN
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Name | MR. TONY FREEMAN
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Credential | M.D.
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Telephone | 615-644-3000
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 104100000X
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Taxonomy Name | Social Worker
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License Number |
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License Number State | TN
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Taxonomy #2
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Taxonomy Code | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number |
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License Number State |
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Taxonomy #4
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number |
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License Number State |
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