Provider Demographics
NPI:1366838369
Name:ROSE INTERNAL MEDICINE
Entity Type:Organization
Organization Name:ROSE INTERNAL MEDICINE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:WILLIAM
Authorized Official - Middle Name:
Authorized Official - Last Name:KUBASKA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:303-320-7340
Mailing Address - Street 1:4545 E 9TH AVE
Mailing Address - Street 2:SUITE 370
Mailing Address - City:DENVER
Mailing Address - State:CO
Mailing Address - Zip Code:80220-3901
Mailing Address - Country:US
Mailing Address - Phone:303-320-7340
Mailing Address - Fax:303-320-7341
Practice Address - Street 1:4545 E 9TH AVE
Practice Address - Street 2:SUITE 370
Practice Address - City:DENVER
Practice Address - State:CO
Practice Address - Zip Code:80220-3901
Practice Address - Country:US
Practice Address - Phone:303-320-7340
Practice Address - Fax:303-320-7341
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-04-07
Last Update Date:2015-04-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO0004148261QP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care