MEDICARE: ROSE CANCER CENTER PC

Medicare Provider Information

Scope of Practice

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

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207RH0003X	Hematology & Oncology Physician	18057	MS

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	255558234A	OTHER	MS	BCBS
3	18057	OTHER	MS	LICENSE

General Provider Information

NPI Number	:	1760585178
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ROSE CANCER CENTER PC

Provider Business Mailing Address
First Line	:	PO BOX 1963
Second Line	:
City	:	MCCOMB
State	:	MS
Zip	:	39649
Country	:	US
Telephone Number	:	601-249-5526
Fax Number	:	601-249-5529

Provider Business Practice Location Address
First Line	:	807 ROBB STREET
Second Line	:
City	:	SUMMIT
State	:	MS
Zip	:	39666
Country	:	US
Telephone Number	:	601-957-7340
Fax Number	:	601-249-5529

Authorized Official
Title or Position	:	PHYSICIAN MEDICAL DIRECTOR
Name	:	MEERA SACHDEVA
Credential	:	MD
Telephone Number	:	601-249-5526

Provider Enumeration Date	:	09/07/2006
Last Update Date	:	12/06/2010

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Directions to “ROSE CANCER CENTER PC ” Practice Location

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