Healthcare Provider Details

I. General information

NPI: 1982632626
Provider Name (Legal Business Name): STEVEN A RUPERT DO LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/29/2006
Last Update Date: 10/26/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2330 LYNCH RD SUITE 100
EVANSVILLE IN
47711-2998
US

IV. Provider business mailing address

2330 LYNCH RD SUITE 100
EVANSVILLE IN
47711-2998
US

V. Phone/Fax

Practice location:
  • Phone: 812-867-9800
  • Fax: 812-867-4720
Mailing address:
  • Phone: 812-867-9800
  • Fax: 812-867-4720

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208100000X
TaxonomyPhysical Medicine & Rehabilitation Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code2081P2900X
TaxonomyPain Medicine (Physical Medicine & Rehabilitation) Physician
License Number
License Number State

VIII. Authorized Official

Name: STEVEN A. RUPERT
Title or Position: OWNER
Credential: D.O.
Phone: 812-867-9800