Healthcare Provider Details

I. General information

NPI: 1871751024
Provider Name (Legal Business Name): AMBULATORY SURGERY CENTER FOR PAIN RELIEF LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/23/2008
Last Update Date: 12/16/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2330 LYNCH RD SUITE 100B
EVANSVILLE IN
47711-2998
US

IV. Provider business mailing address

2330 LYNCH RD SUITE 100B
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 TaxonomyY
Taxonomy Code261QA1903X
TaxonomyAmbulatory Surgical Clinic/Center
License Number
License Number StateIN

VIII. Authorized Official

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