Provider Demographics
NPI:1073696035
Name:ROSE MEDICAL EQUIPMENT, INC
Entity Type:Organization
Organization Name:ROSE MEDICAL EQUIPMENT, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ROSE
Authorized Official - Middle Name:
Authorized Official - Last Name:JOHNSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:601-446-8907
Mailing Address - Street 1:2825 ROSELAWN DR
Mailing Address - Street 2:
Mailing Address - City:NATCHEZ
Mailing Address - State:MS
Mailing Address - Zip Code:39120-4048
Mailing Address - Country:US
Mailing Address - Phone:601-442-0087
Mailing Address - Fax:601-445-7473
Practice Address - Street 1:261 D' EVEREAUX DR
Practice Address - Street 2:STE. 20
Practice Address - City:NATCHEZ
Practice Address - State:MS
Practice Address - Zip Code:39120-3783
Practice Address - Country:US
Practice Address - Phone:601-442-0087
Practice Address - Fax:601-445-7473
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-23
Last Update Date:2009-04-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS8313151332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS03270775Medicaid
LA1304913Medicaid
MS03270775Medicaid