Provider Demographics
NPI:1225283930
Name:RUPP UROLOGY LLC
Entity Type:Organization
Organization Name:RUPP UROLOGY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:BRADLEY
Authorized Official - Middle Name:W
Authorized Official - Last Name:RUPP
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:785-354-7877
Mailing Address - Street 1:631 SW HORNE ST
Mailing Address - Street 2:SUITE 150
Mailing Address - City:TOPEKA
Mailing Address - State:KS
Mailing Address - Zip Code:66606-1694
Mailing Address - Country:US
Mailing Address - Phone:785-354-7877
Mailing Address - Fax:785-354-7878
Practice Address - Street 1:631 SW HORNE ST
Practice Address - Street 2:SUITE 150
Practice Address - City:TOPEKA
Practice Address - State:KS
Practice Address - Zip Code:66606-1694
Practice Address - Country:US
Practice Address - Phone:785-354-7877
Practice Address - Fax:785-354-7878
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-11-21
Last Update Date:2009-11-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208800000XAllopathic & Osteopathic PhysiciansUrologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
6213140001Medicare NSC