Organization
ROSE INTERNAL MEDICINE, P.C.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
BECKY ROSE (OFFICE MANAGER)
(812) 961-6961
Entity
Organization
Contact information
Practice address
2205 W SUDBURY DR, SUITE A, BLOOMINGTON, IN 47403-3737
(812) 961-1540
(812) 961-1535
Mailing address
2205 W SUDBURY DR, SUITE A, BLOOMINGTON, IN 47403-3737
(812) 961-1540
(812) 961-1535
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
01054413A
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
200513720A
—
IN
01
—
DD5526
RAILROAD MEDICARE
IN
Enumeration date
11/01/2005
Last updated
09/22/2011
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