| Rose Internal Medicine, P.c. | |
|
2205 W Sudbury Dr Suite A Bloomington IN 47403-3737 | |
| (812) 961-1540 | |
| (812) 961-1535 |
| Full Name | Rose Internal Medicine, P.c. |
|---|---|
| Speciality | Internal Medicine |
| Location | 2205 W Sudbury Dr, Bloomington, Indiana |
| Authorized Official Name and Position | Becky Rose (OFFICE MANAGER) |
| Authorized Official Contact | 8129616961 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Rose Internal Medicine, P.c. 2205 W Sudbury Dr Suite A Bloomington IN 47403-3737 Ph: (812) 961-1540 | Rose Internal Medicine, P.c. 2205 W Sudbury Dr Suite A Bloomington IN 47403-3737 Ph: (812) 961-1540 |
| NPI Number | 1992796718 |
|---|---|
| Provider Enumeration Date | 11/01/2005 |
| Last Update Date | 09/22/2011 |
| Medicare PECOS PAC ID | 6406895150 |
|---|---|
| Medicare Enrollment ID | O20050502000877 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1992796718 | NPI | - | NPPES |
| 200513720A | Medicaid | IN | |
| DD5526 | Other | IN | RAILROAD MEDICARE |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207R00000X | Internal Medicine | 01054413A (Indiana) | Primary |
| Provider Name | Charles H Rose |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1477544153 PECOS PAC ID: 4587603246 Enrollment ID: I20050502000936 |
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