Councill C Rudolph, MD is a
Surgery physician based in Manchester, Tennessee. Councill C Rudolph is licensed to practice in Tennessee (license number MD0000025899) and his current practice location is 822 Mcarthur St, Manchester, Tennessee. He can be reached at his office (for appointments etc.) via phone at
(931) 723-7121.
NPI number for Councill C Rudolph is 1194760660 and his current mailing address is 15 Veterans Dr, Decherd, Tennessee. He
does not participate in medicare program and thus does not accept medicare assignments. His NPI Number is 1194760660.
Physician's Profile
| Full Name | Councill C Rudolph |
|---|
| Gender | Male |
|---|
| Speciality | Surgery |
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| Location | 822 Mcarthur St, Manchester, Tennessee |
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| Accepts Medicare Assignments | Does not participate in Medicare Program. He may not accept medicare assignment. |
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NPI Data:
- NPI Number: 1194760660
- Provider Enumeration Date: 06/18/2006
- Last Update Date: 04/14/2016
Medical Identifiers
Medical identifiers for Councill C Rudolph such as npi, medicare ID, medicare PIN, medicaid, etc.
| Identifier | Type | State | Issuer |
|---|
| 1194760660 | NPI | - | NPPES |
| 3091133 | Medicaid | TN | |
Medical Taxonomies and Licenses
| Taxonomy | Type | License (State) | Status |
|---|
| 208600000X | Surgery | MD0000025899 (Tennessee) | Primary |
Medicare Part D Prescriber Enrollment
Any physician or other eligible professional who prescribes Part D drugs must either enroll in the Medicare program or opt out in order to prescribe drugs to their patients with Part D prescription drug benefit plans. Councill C Rudolph is
NOT enrolled with medicare and thus cannot prescribe medicare part D drugs to patients with medicare part D benefits.
Mailing Address and Practice Location
| Mailing Address | Practice Location Address |
|---|
Councill C Rudolph, MD
15 Veterans Dr,
Decherd, TN 37324-3887
Ph: (931) 962-2273 | Councill C Rudolph, MD
822 Mcarthur St,
Manchester, TN 37355-2324
Ph: (931) 723-7121 |
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