Provider Demographics
NPI:1114133055
Name:DRS ROSE AND THOMAS
Entity Type:Organization
Organization Name:DRS ROSE AND THOMAS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:LPN OFFICE MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:SHARON
Authorized Official - Middle Name:DAWN
Authorized Official - Last Name:HAROLD
Authorized Official - Suffix:
Authorized Official - Credentials:LPN OFFICE MANAGER
Authorized Official - Phone:606-248-7509
Mailing Address - Street 1:PO BOX 1679
Mailing Address - Street 2:
Mailing Address - City:NEW TAZEWELL
Mailing Address - State:TN
Mailing Address - Zip Code:37825-1679
Mailing Address - Country:US
Mailing Address - Phone:423-626-4288
Mailing Address - Fax:423-626-1101
Practice Address - Street 1:123 N 19TH ST
Practice Address - Street 2:
Practice Address - City:MIDDLESBORO
Practice Address - State:KY
Practice Address - Zip Code:40965
Practice Address - Country:US
Practice Address - Phone:606-248-7509
Practice Address - Fax:606-248-5917
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-15
Last Update Date:2010-04-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208600000XAllopathic & Osteopathic PhysiciansSurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY65941957Medicaid
KYCA4245Medicare PIN
KY65941957Medicaid