Organization
ROSE MEDICAL GROUP LTD
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. EDWARD P ROSE M.D. (OWNER)
(618) 257-1490
Entity
Organization
Contact information
Practice address
4600 MEMORIAL DR, SUITE 480 MEDICAL BLDG #2, BELLEVILLE, IL 62226-5366
(618) 257-1490
(618) 222-6819
Mailing address
4600 MEMORIAL DR, SUITE 480 MEDICAL BLDG #2, BELLEVILLE, IL 62226-5366
(618) 257-1490
(618) 222-6819
Taxonomy
Speciality
Code
Description
License number
State
207RR0500X
Rheumatology Physician
R4736
MO
207RR0500X
Rheumatology Physician
Primary
—
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
8225530
IL BLUE CROSS BLUE SHIELD
IL
Enumeration date
08/02/2006
Last updated
10/05/2007
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