Provider Demographics
NPI:1982632626
Name:STEVEN A RUPERT DO LLC
Entity Type:Organization
Organization Name:STEVEN A RUPERT DO LLC
Other - Org Name:MEDICAL CENTER FOR PAIN RELIEF
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
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 100
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:812-867-4720
Practice Address - Street 1:2330 LYNCH RD
Practice Address - Street 2:SUITE 100
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:812-867-4720
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-29
Last Update Date:2015-10-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2081P2900XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationPain MedicineGroup - Single Specialty
No208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationGroup - Single Specialty
No363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult HealthGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN200850420AMedicaid
IN200850420AMedicaid