1316156581 NPI number — BECKY ROSE RUPERT ND, CNC, CCH

Table of content: BECKY ROSE RUPERT ND, CNC, CCH (NPI 1316156581)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1316156581 NPI number — BECKY ROSE RUPERT ND, CNC, CCH

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
RUPERT
Provider First Name:
BECKY
Provider Middle Name:
ROSE
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
ND, CNC, CCH
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1316156581
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/18/2013
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
12931 N. ELYRIA RD.
Provider Second Line Business Mailing Address:
PO BOX 535
Provider Business Mailing Address City Name:
WEST SALEM
Provider Business Mailing Address State Name:
OH
Provider Business Mailing Address Postal Code:
44287-9796
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
419-853-3805
Provider Business Mailing Address Fax Number:
419-853-4741

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
12931 N. ELYRIA RD.
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
WEST SALEM
Provider Business Practice Location Address State Name:
OH
Provider Business Practice Location Address Postal Code:
44287-9796
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
419-853-3805
Provider Business Practice Location Address Fax Number:
419-853-4741
Provider Enumeration Date:
05/22/2007

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 175F00000X , with the licence number:  001120141 , registered in the state of NC ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 175L00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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