Provider Demographics
NPI:1063503712
Name:PAPUCHIS, TRUDY A (MD)
Entity Type:Individual
Prefix:
First Name:TRUDY
Middle Name:A
Last Name:PAPUCHIS
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 525
Mailing Address - Street 2:
Mailing Address - City:HUNTINGDON
Mailing Address - State:TN
Mailing Address - Zip Code:38344-0525
Mailing Address - Country:US
Mailing Address - Phone:731-986-2213
Mailing Address - Fax:731-986-0011
Practice Address - Street 1:600 RB WILSON DR
Practice Address - Street 2:
Practice Address - City:HUNTINGDON
Practice Address - State:TN
Practice Address - Zip Code:38344-1726
Practice Address - Country:US
Practice Address - Phone:731-986-2213
Practice Address - Fax:731-986-0011
Is Sole Proprietor?:No
Enumeration Date:2006-09-27
Last Update Date:2012-02-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN19459207ZP0102X, 208D00000X
KY24228207ZP0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
No207ZP0102XAllopathic & Osteopathic PhysiciansPathologyAnatomic Pathology & Clinical Pathology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN0179492OtherBLUE CROSS
TN100031425OtherPHP TENNCARE
TN3048641Medicaid
TN119454OtherUNISON TENNCARE
TN000005007805OtherTLC TENNCARE
AL009963880Medicaid
KY64242282Medicaid
F03970Medicare UPIN
AL009963880Medicaid
220023611Medicare ID - Type UnspecifiedRAILROAD MEDICARE