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General NPI Number Information
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NPI Number | 1386726727
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Entity Type | Organization
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Legal Business Name | ROSE MEDICAL, LLC
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Dates
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Enumeration Date | 10/19/2006
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 100 GROSS CRESCENT CIR SUITE 201
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City | FORT OGLETHORPE
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State | GA
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Zip | 30742-3643
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Country | US
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Telephone | 513-550-1305
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Fax |
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Provider Business Mailing Address
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Address Line | 100 GROSS CRESCENT CIR SUITE 201
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City | FORT OGLETHORPE
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State | GA
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Zip | 30742-3643
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. ROBERT W HORACEK
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Credential | M.D.
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Telephone | 513-550-1305
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number |
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License Number State |
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