Provider Demographics
NPI:1871762427
Name:RUPP MEDICAL ASSOCIATES
Entity type:Organization
Organization Name:RUPP MEDICAL ASSOCIATES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:ALLEN
Authorized Official - Last Name:RUPP
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:724-437-1568
Mailing Address - Street 1:295 MORGANTOWN ST
Mailing Address - Street 2:
Mailing Address - City:UNIONTOWN
Mailing Address - State:PA
Mailing Address - Zip Code:15401-4723
Mailing Address - Country:US
Mailing Address - Phone:724-437-1568
Mailing Address - Fax:724-437-1560
Practice Address - Street 1:295 MORGANTOWN ST
Practice Address - Street 2:BOX 1204
Practice Address - City:UNIONTOWN
Practice Address - State:PA
Practice Address - Zip Code:15401-4723
Practice Address - Country:US
Practice Address - Phone:724-437-1568
Practice Address - Fax:724-437-1560
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-02-28
Last Update Date:2008-02-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOEG-000973152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0330400001Medicare NSC