Provider Demographics
NPI:1083640247
Name:DEAN ROSECRANS
Entity Type:Organization
Organization Name:DEAN ROSECRANS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:DEAN
Authorized Official - Middle Name:
Authorized Official - Last Name:ROSECRANS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:208-466-8000
Mailing Address - Street 1:PO BOX 310
Mailing Address - Street 2:
Mailing Address - City:NAMPA
Mailing Address - State:ID
Mailing Address - Zip Code:83653-0310
Mailing Address - Country:US
Mailing Address - Phone:208-467-4790
Mailing Address - Fax:208-465-5951
Practice Address - Street 1:424 7TH AVE S
Practice Address - Street 2:
Practice Address - City:NAMPA
Practice Address - State:ID
Practice Address - Zip Code:83651-4168
Practice Address - Country:US
Practice Address - Phone:208-467-4790
Practice Address - Fax:208-465-5951
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-22
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
ID0184140001Medicare NSC