# ROSE MEDICAL GROUP LTD

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1548277452
- **Authorized official:** MR. EDWARD P ROSE M.D. (OWNER)
- **Authorized official phone:** (618) 257-1490

## Contact information

- **Practice address:** 4600 MEMORIAL DR, SUITE 480 MEDICAL BLDG \#2, BELLEVILLE, IL 62226-5366
- **Practice address phone:** (618) 257-1490
- **Practice address fax:** (618) 222-6819
- **Mailing address:** 4600 MEMORIAL DR, SUITE 480 MEDICAL BLDG \#2, BELLEVILLE, IL 62226-5366
- **Mailing address phone:** (618) 257-1490
- **Mailing address fax:** (618) 222-6819

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 207RR0500X | Rheumatology Physician | R4736 | MO | — |
| 207RR0500X | Rheumatology Physician | — | IL | Yes |

## Other

- **Enumeration date:** 08/02/2006
- **Last updated:** 10/05/2007

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 01 | — | 8225530 | IL BLUE CROSS BLUE SHIELD | IL |