Provider Demographics
NPI:1891053823
Name:CELEBRATION FAMILY CARE PLLC
Entity Type:Organization
Organization Name:CELEBRATION FAMILY CARE PLLC
Other - Org Name:HOWARD J RUPARD SOLE MBR
Other - Org Type:Other Name
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MR
Authorized Official - First Name:CHAD
Authorized Official - Middle Name:
Authorized Official - Last Name:GRAHAM
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:931-580-0112
Mailing Address - Street 1:529 W COMMERCE ST
Mailing Address - Street 2:
Mailing Address - City:LEWISBURG
Mailing Address - State:TN
Mailing Address - Zip Code:37091-3219
Mailing Address - Country:US
Mailing Address - Phone:931-270-9729
Mailing Address - Fax:931-270-9926
Practice Address - Street 1:529 W COMMERCE ST
Practice Address - Street 2:
Practice Address - City:LEWISBURG
Practice Address - State:TN
Practice Address - Zip Code:37091-3219
Practice Address - Country:US
Practice Address - Phone:931-270-9729
Practice Address - Fax:931-270-9926
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-04-27
Last Update Date:2015-05-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNMD024783207Q00000X
261QR1300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QR1300XAmbulatory Health Care FacilitiesClinic/CenterRural Health
No207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TNF01423Medicare UPIN
TN448946Medicare PIN