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Douglas J. Rose

Family Medicine

Allopathic & Osteopathic Physicians

102 E Ravine Rd, Kingsport, TN 37660-3814

PECOS Enrollment

This provider is enrolled in PECOS as DOUGLAS ROSE.

Based on the most recent information from CMS, provider Douglas J. Rose is legally eligible to order and refer claims for Part B, HHA, DME and PMD services.

Part B
Medicare Part B
Enrolled
HHA
Home Health Agency
Enrolled
DME
Durable Medical Equipment
Enrolled
PMD
Power Mobility Device
Enrolled

CMS last updated its PECOS records 2 days ago.

Profile Details

Provider ID
1003892027
Provider Type
Individual
Full Name
Rose, Douglas J.
Credential
M.D.

Gender
Male
Sole Proprietor
No
Enumeration Date
12/21/2005
Last Updated
2/8/2016

Contact Information

Practice Location

102 E Ravine Rd, Kingsport, TN 37660-3814

(423) 245-9600

(423) 245-9634

Mailing Location

PO Box 699, Mountain Home, TN 37684-0699

(423) 245-9600

(423) 245-9634

Provider Taxonomies

Code	Description	License
Code 207Q00000X Primary	Description Family Medicine Allopathic & Osteopathic Physicians	License 36384 Tennessee

Douglas J. Rose

PECOS Enrollment

Profile Details

Contact Information

Practice Location

Mailing Location

Provider Taxonomies

Code

Description

License

Code

Description

License

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