1720011869 NPI number — CAROLYN LOUISE SEIFERT MD

Table of content: CAROLYN LOUISE SEIFERT MD (NPI 1720011869)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1720011869 NPI number — CAROLYN LOUISE SEIFERT MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
SEIFERT
Provider First Name:
CAROLYN
Provider Middle Name:
LOUISE
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
MD
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
ESCOTT
Provider Other First Name:
CAROLYN
Provider Other Middle Name:
L
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1720011869
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
11/09/2015
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
900 E LAHARPE ST
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
KIRKSVILLE
Provider Business Mailing Address State Name:
MO
Provider Business Mailing Address Postal Code:
63501-4520
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
660-665-1962
Provider Business Mailing Address Fax Number:
660-665-3989

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
141 COMMUNICATION DR
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
HANNIBAL
Provider Business Practice Location Address State Name:
MO
Provider Business Practice Location Address Postal Code:
63401-3670
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
573-603-1460
Provider Business Practice Location Address Fax Number:
573-603-1462
Provider Enumeration Date:
07/09/2006

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 2084P0800X , with the licence number:  32701 , registered in the state of IA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 2084P0800X , with the licence number: 036.098923 , registered in the state of IL ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 2084P0800X , with the licence number: R2J61 , registered in the state of MO ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)