Organization Name: | OUR LADY OF THE ROSES PRIMARY CARE |
NPI Number: | 1801119375 |
Entity Type Code: | Organizational (2) |
Authorized Official Name: | GERALD W. WIECZOREK (REGISTERING AGENT) |
Mailing Address: | 808 21st St Columbus |
State: | GA US |
Postal Code: | 319048817 |
Phone Number: | 7062217232 |
Fax Number: | 7062217246 |
NPI Enumeration Date: | 03/11/2010 |
NPI Last Update Date: | 02/25/2014 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 208D00000X |
License Number: | |
Healthcare Provider Taxonomy: (Secondary) | N |
State: | |
Taxonomy Type: | Allopathic & Osteopathic Physicians |
Taxonomy Classification: | General Practice |
Taxonomy Specialization: | |
Taxonomy Definition: |