1053316489 NPI number — SUSAN M KAUFMAN D.O

Table of content: SUSAN M KAUFMAN D.O (NPI 1053316489)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1053316489 NPI number — SUSAN M KAUFMAN D.O

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
KAUFMAN
Provider First Name:
SUSAN
Provider Middle Name:
M
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
D.O
Provider Gender Code:
F

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:
1053316489
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
10/27/2016
NPI Deactivation Reason Code:
NPI Deactivation Date:
03/17/2006
NPI Reactivation Date:
03/27/2006

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
951 COMMERCE PKWY
Provider Second Line Business Mailing Address:
SUITE 101
Provider Business Mailing Address City Name:
LIMA
Provider Business Mailing Address State Name:
OH
Provider Business Mailing Address Postal Code:
45804-4040
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
419-998-4575
Provider Business Mailing Address Fax Number:
419-998-4586

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1251 LINCOLN HWY
Provider Second Line Business Practice Location Address:
SUITE 1
Provider Business Practice Location Address City Name:
WAPAKONETA
Provider Business Practice Location Address State Name:
OH
Provider Business Practice Location Address Postal Code:
45895-7356
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
419-738-5151
Provider Business Practice Location Address Fax Number:
419-941-1092
Provider Enumeration Date:
06/13/2005

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: 207Q00000X , with the licence number:  OS006866L , registered in the state of PA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 207Q00000X , with the licence number: 34010062 , registered in the state of OH ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 25-1754199 . This is a "SELECTCARE" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 0025215401 . This is a "UNIVERA INSURANCE CO" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: 080169885 . This is a "RAILROAD MEDICARE PIN" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 25-1754199 . This is a "INTERGROUP" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 2725313 . This is a "CIGNA" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 0011702840010 , issued by the state of ( PA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 25-1754199 . This is a "UNITED HEALTHCARE" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 303685 . This is a "UPMC HEALTH PLAN" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: KA580453 . This is a "HIGHMARK" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 0011702840011 , issued by the state of ( PA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 0011702840005 , issued by the state of ( PA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 25-1754199 . This is a "DEVON" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 3126316 , issued by the state of ( OH ) . This identifiers is of the category "MEDICAID".
  • Identifier: 25-1754199 . This is a "VANTAGE" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 580453 . This is a "BLUE SHIELD" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 25-1754199 . This is a "HEALTH AMERICA" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".




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