Basic Information
| Provider Information | |||||||||
| NPI: | 1487896130 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | ESTELLE A. RUTLEDGE, M.D., PA | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 9150 | ||||||||
| Address2: | |||||||||
| City: | PADUCAH | ||||||||
| State: | KY | ||||||||
| PostalCode: | 420029150 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2707449600 | ||||||||
| FaxNumber: | 2707440834 | ||||||||
| Practice Location | |||||||||
| Address1: | 23157 I-30 SOUTH | ||||||||
| Address2: | SUITE 200 | ||||||||
| City: | BRYANT | ||||||||
| State: | AR | ||||||||
| PostalCode: | 720222593 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5018470834 | ||||||||
| FaxNumber: | 5018471731 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 03/26/2009 | ||||||||
| LastUpdateDate: | 08/23/2010 | ||||||||
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| AuthorizedOfficialLastName: | RUTLEDGE | ||||||||
| AuthorizedOfficialFirstName: | ESTELLE | ||||||||
| AuthorizedOfficialMiddleName: | ALEXIS | ||||||||
| AuthorizedOfficialTitleorPosition: | OWNER | ||||||||
| AuthorizedOfficialTelephone: | 5019601390 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | DR. | ||||||||
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| AuthorizedOfficialCredential: | M.D. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207V00000X | E-6039 | AR | Y | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Obstetrics & Gynecology |
ID Information
| ID | Type | State | Issuer | Description | 177688002 | 05 | AR | MEDICAID |