MEDICARE: ROSE MEDICAL PAVILION PLLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy
1	2084N0402X	Neurology with Special Qualifications in Child Neurology Physician
2	261Q00000X	Clinic/Center
3	261QX0200X	Oncology Clinic/Center

General Provider Information

NPI Number	:	1154101152
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ROSE MEDICAL PAVILION PLLC

Provider Business Mailing Address
First Line	:	22044 N 44TH ST STE 200
Second Line	:
City	:	PHOENIX
State	:	AZ
Zip	:	85050-6104
Country	:	US
Telephone Number	:	623-257-7673
Fax Number	:	623-257-7344

Provider Business Practice Location Address
First Line	:	22044 N 44TH ST STE 200
Second Line	:
City	:	PHOENIX
State	:	AZ
Zip	:	85050-6104
Country	:	US
Telephone Number	:	602-341-5035
Fax Number	:

Authorized Official
Title or Position	:	PHYSICIAN OWNER
Name	:	TAMARA ZACH
Credential	:	MD
Telephone Number	:	623-257-7673

Provider Enumeration Date	:	10/05/2023
Last Update Date	:	01/12/2026

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