Provider Demographics
NPI:1942420765
Name:RUPE, SCOTT HENRY
Entity Type:Individual
Prefix:MR
First Name:SCOTT
Middle Name:HENRY
Last Name:RUPE
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1439 THOMAS CIR
Mailing Address - Street 2:
Mailing Address - City:COOKEVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:38506-5903
Mailing Address - Country:US
Mailing Address - Phone:931-528-7304
Mailing Address - Fax:
Practice Address - Street 1:1420 NEAL ST
Practice Address - Street 2:STE 220
Practice Address - City:COOKEVILLE
Practice Address - State:TN
Practice Address - Zip Code:38501-4333
Practice Address - Country:US
Practice Address - Phone:931-525-6900
Practice Address - Fax:931-525-6970
Is Sole Proprietor?:No
Enumeration Date:2007-04-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL850390171M00000X
TN4785756171M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator