Provider Demographics
NPI:1760585178
Name:ROSE CANCER CENTER PC
Entity Type:Organization
Organization Name:ROSE CANCER CENTER PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN MEDICAL DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:MEERA
Authorized Official - Middle Name:
Authorized Official - Last Name:SACHDEVA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:601-249-5526
Mailing Address - Street 1:PO BOX 1963
Mailing Address - Street 2:
Mailing Address - City:MCCOMB
Mailing Address - State:MS
Mailing Address - Zip Code:39649
Mailing Address - Country:US
Mailing Address - Phone:601-249-5526
Mailing Address - Fax:601-249-5529
Practice Address - Street 1:807 ROBB STREET
Practice Address - Street 2:
Practice Address - City:SUMMIT
Practice Address - State:MS
Practice Address - Zip Code:39666
Practice Address - Country:US
Practice Address - Phone:601-957-7340
Practice Address - Fax:601-249-5529
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-07
Last Update Date:2010-12-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS18057207RH0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RH0003XAllopathic & Osteopathic PhysiciansInternal MedicineHematology & OncologyGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS08534501Medicaid
MS255558234AOtherBCBS
MS18057OtherLICENSE
MSC03605Medicare PIN
G39923Medicare UPIN