Healthcare Provider Details

I. General information

NPI: 1053319376
Provider Name (Legal Business Name): STEVIE TROSPER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/11/2005
Last Update Date: 08/04/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1930 CUMBERLAND AVE
MIDDLESBORO KY
40965-1231
US

IV. Provider business mailing address

1930 CUMBERLAND AVE
MIDDLESBORO KY
40965-1231
US

V. Phone/Fax

Practice location:
  • Phone: 606-248-9020
  • Fax: 606-248-9015
Mailing address:
  • Phone: 606-248-9020
  • Fax: 606-248-9015

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number258490
License Number StateKY

VIII. Authorized Official

Name: MR. STEVE TROSPER
Title or Position: OWNER
Credential:
Phone: 606-248-9020