Provider Demographics
NPI:1952369902
Name:THOMAS W. KUPFERER, D.O.
Entity Type:Organization
Organization Name:THOMAS W. KUPFERER, D.O.
Other - Org Name:MURPHYSBORO FAMILY MEDICINE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:JANET
Authorized Official - Middle Name:LEAH
Authorized Official - Last Name:AUSTIN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:618-687-2353
Mailing Address - Street 1:628 N 14TH ST
Mailing Address - Street 2:
Mailing Address - City:MURPHYSBORO
Mailing Address - State:IL
Mailing Address - Zip Code:62966-1807
Mailing Address - Country:US
Mailing Address - Phone:618-687-2353
Mailing Address - Fax:618-687-9511
Practice Address - Street 1:628 N 14TH ST
Practice Address - Street 2:MURPHYSBORO FAMILY MEDICINE
Practice Address - City:MURPHYSBORO
Practice Address - State:IL
Practice Address - Zip Code:62966-1807
Practice Address - Country:US
Practice Address - Phone:618-687-2353
Practice Address - Fax:618-687-9511
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-01
Last Update Date:2009-10-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036066913207Q00000X, 261QR1300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
No261QR1300XAmbulatory Health Care FacilitiesClinic/CenterRural HealthGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL143855OtherOSCAR/MEDICARE
IL039-00152OtherBCBS
IL350468093001Medicaid
IL143855OtherOSCAR/MEDICARE
IL039-00152OtherBCBS