Provider Demographics
NPI:1376708735
Name:AMBULATORY SURGERY CENTER FOR PAIN RELIEF LLC
Entity Type:Organization
Organization Name:AMBULATORY SURGERY CENTER FOR PAIN RELIEF LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEDICAL DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:STEVEN
Authorized Official - Middle Name:A
Authorized Official - Last Name:RUPERT
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:812-867-9800
Mailing Address - Street 1:2330 LYNCH RD
Mailing Address - Street 2:SUITE 100B
Mailing Address - City:EVANSVILLE
Mailing Address - State:IN
Mailing Address - Zip Code:47711-2998
Mailing Address - Country:US
Mailing Address - Phone:812-867-9800
Mailing Address - Fax:867-437-4707
Practice Address - Street 1:2330 LYNCH RD
Practice Address - Street 2:SUITE 100B
Practice Address - City:EVANSVILLE
Practice Address - State:IN
Practice Address - Zip Code:47711-2998
Practice Address - Country:US
Practice Address - Phone:812-867-9800
Practice Address - Fax:867-437-4707
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-07-25
Last Update Date:2008-07-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN261QA1903X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Surgical