1891724738 NPI number — SETH I KAUFMAN MD

Table of content: SETH I KAUFMAN MD (NPI 1891724738)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1891724738 NPI number — SETH I KAUFMAN MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
KAUFMAN
Provider First Name:
SETH
Provider Middle Name:
I
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
MD
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1891724738
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
02/08/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
100 N HUMPHREYS BLVD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
MEMPHIS
Provider Business Mailing Address State Name:
TN
Provider Business Mailing Address Postal Code:
38120-2146
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
901-683-0055
Provider Business Mailing Address Fax Number:
901-685-9718

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
210 WESTWOOD PL STE 110
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
BRENTWOOD
Provider Business Practice Location Address State Name:
TN
Provider Business Practice Location Address Postal Code:
37027-7554
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
901-683-6152
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
07/02/2006

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: 208VP0000X , with the licence number:  17581 , registered in the state of TN ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 208VP0000X , with the licence number: 11868 , registered in the state of MS ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 207LA0401X , with the licence number: 17581 , registered in the state of TN ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 07830832 , issued by the state of ( MS ) . This identifiers is of the category "MEDICAID".
  • Identifier: 1592714 , issued by the state of ( LA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 125756001 , issued by the state of ( AR ) . This identifiers is of the category "MEDICAID".
  • Identifier: 3028135 , issued by the state of ( TN ) . This identifiers is of the category "MEDICAID".
  • Identifier: 90087 . This is a "BCBS AR" identifier , issued by the state of ( AR ) . This identifiers is of the category "OTHER".
  • Identifier: 208798009 , issued by the state of ( MO ) . This identifiers is of the category "MEDICAID".
  • Identifier: 4048883 . This is a "BCBS TN" identifier , issued by the state of ( TN ) . This identifiers is of the category "OTHER".
  • Identifier: 4062326 . This is a "AETNA" identifier , issued by the state of ( TN ) . This identifiers is of the category "OTHER".




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