Organization
ROBERTA EDMUNDSON ROSE M D INC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
ROBERTA EDMUNDSON ROSE M.D. (PRESIDENT)
(574) 269-5221
Entity
Organization
Contact information
Practice address
800 E CENTER ST, WARSAW, IN 46580-3325
(574) 269-5221
(574) 269-5580
Mailing address
PO BOX 1222, WARSAW, IN 46581-1222
(574) 269-5221
(574) 269-5580
Taxonomy
Speciality
Code
Description
License number
State
207X00000X
Orthopaedic Surgery Physician
Primary
01029953A
IN
332B00000X
Durable Medical Equipment & Medical Supplies
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
128983500
DEPARTMENT OF LABOR FECA
—
Enumeration date
04/20/2007
Last updated
11/17/2008
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