Provider Demographics
NPI:1083854731
Name:MEADE COUNTY PEDIATRICS PLLC
Entity Type:Organization
Organization Name:MEADE COUNTY PEDIATRICS PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:L
Authorized Official - Last Name:KUPPER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:270-422-3400
Mailing Address - Street 1:1010 LAWRENCE STREET
Mailing Address - Street 2:
Mailing Address - City:BRANDENBURG
Mailing Address - State:KY
Mailing Address - Zip Code:40108-1401
Mailing Address - Country:US
Mailing Address - Phone:270-422-3400
Mailing Address - Fax:
Practice Address - Street 1:1010 LAWRENCE STREET
Practice Address - Street 2:
Practice Address - City:BRANDENBURG
Practice Address - State:KY
Practice Address - Zip Code:40108-1401
Practice Address - Country:US
Practice Address - Phone:270-422-3400
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-02-20
Last Update Date:2022-06-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Single Specialty
No363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedicalGroup - Multi-Specialty
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGroup - Multi-Specialty