Provider Demographics
NPI:1780952267
Name:ROSA OF NORTH DALLAS LLC
Entity type:Organization
Organization Name:ROSA OF NORTH DALLAS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIEF OPERATING OFFICER
Authorized Official - Prefix:
Authorized Official - First Name:GREGORY
Authorized Official - Middle Name:S
Authorized Official - Last Name:MERRILL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:615-250-1798
Mailing Address - Street 1:320 SEVEN SPRINGS WAY
Mailing Address - Street 2:SUITE 220
Mailing Address - City:BRENTWOOD
Mailing Address - State:TN
Mailing Address - Zip Code:37027-4537
Mailing Address - Country:US
Mailing Address - Phone:615-250-1798
Mailing Address - Fax:615-250-1644
Practice Address - Street 1:12606 GREENVILLE AVE
Practice Address - Street 2:SUITE 160
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75243-1921
Practice Address - Country:US
Practice Address - Phone:469-364-7880
Practice Address - Fax:469-364-7895
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:RADIATION ONCOLOGY SERVICES OF AMERICA INC.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2011-12-12
Last Update Date:2011-12-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2085R0001XAllopathic & Osteopathic PhysiciansRadiologyRadiation OncologyGroup - Single Specialty