Provider Demographics
NPI:1972698876
Name:ROSEMAR MEDICAL CORPORATION
Entity Type:Organization
Organization Name:ROSEMAR MEDICAL CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:E
Authorized Official - Last Name:BEANE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:304-485-6130
Mailing Address - Street 1:4 ROSEMAR CIR
Mailing Address - Street 2:
Mailing Address - City:PARKERSBURG
Mailing Address - State:WV
Mailing Address - Zip Code:26104-1204
Mailing Address - Country:US
Mailing Address - Phone:304-485-6130
Mailing Address - Fax:304-485-1519
Practice Address - Street 1:4 ROSEMAR CIR
Practice Address - Street 2:
Practice Address - City:PARKERSBURG
Practice Address - State:WV
Practice Address - Zip Code:26104-1204
Practice Address - Country:US
Practice Address - Phone:304-485-6130
Practice Address - Fax:304-485-1519
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-04
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV008419207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WV013332OtherCOLA ID#
WV1802554000Medicaid
WV0044523000Medicaid
WV0048235000Medicaid
WV013332OtherCOLA ID#
WVC34930Medicare UPIN
WVH58287Medicare UPIN
WV1802554000Medicaid
WV0884801Medicare ID - Type UnspecifiedMICHAEL E. BEANE, MD
WV0048235000Medicaid