1295732055 NPI number — STEVEN A RUPERT D.O

Table of content: STEVEN A RUPERT D.O (NPI 1295732055)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1295732055 NPI number — STEVEN A RUPERT D.O

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
RUPERT
Provider First Name:
STEVEN
Provider Middle Name:
A
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
D.O
Provider Gender Code:
M

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:
1295732055
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
03/10/2025
NPI Deactivation Reason Code:
NPI Deactivation Date:
03/20/2006
NPI Reactivation Date:
03/24/2006

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
5925 OLD HWY 60
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
PADUCAH
Provider Business Mailing Address State Name:
KY
Provider Business Mailing Address Postal Code:
42001
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
270-228-0118
Provider Business Mailing Address Fax Number:
270-228-0120

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
5925 OLD HWY 60
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
PADUCAH
Provider Business Practice Location Address State Name:
KY
Provider Business Practice Location Address Postal Code:
42001
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
270-228-0118
Provider Business Practice Location Address Fax Number:
270-228-0120
Provider Enumeration Date:
07/07/2005

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: 2081P2900X , with the licence number:  02001097 , registered in the state of IN ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 64873391 , issued by the state of ( IN ) . This identifiers is of the category "MEDICAID".
  • Identifier: 200850420A , issued by the state of ( IN ) . This identifiers is of the category "MEDICAID".
  • Identifier: 100179690 , issued by the state of ( IN ) . This identifiers is of the category "MEDICAID".




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