1275722183 NPI number — SUMA K SARAFF MD INC

Table of content: (NPI 1275722183)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1275722183 NPI number — SUMA K SARAFF MD INC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
SUMA K SARAFF MD INC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
6
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:
1275722183
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
11/17/2014
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 911065
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
LEXINGTON
Provider Business Mailing Address State Name:
KY
Provider Business Mailing Address Postal Code:
40591-1065
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
859-278-1982
Provider Business Mailing Address Fax Number:
859-278-0095

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1401 HARRODSBURG RD
Provider Second Line Business Practice Location Address:
SUITE B-395
Provider Business Practice Location Address City Name:
LEXINGTON
Provider Business Practice Location Address State Name:
KY
Provider Business Practice Location Address Postal Code:
40504-3751
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
859-278-1982
Provider Business Practice Location Address Fax Number:
859-278-0095
Provider Enumeration Date:
10/16/2007

Additional Information

Authorized Official

Authorized Official Last Name:
SARAFF
Authorized Official First Name:
SUMA
Authorized Official Middle Name:
K
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
859-278-1982

Provider Taxonomy Codes

  • Taxonomy code: 207R00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 363LF0000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

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

  • Identifier: 0007996296 . This is a "AETNA" identifier . This identifiers is of the category "OTHER".
  • Identifier: 000000256300 . This is a "BC/BC" identifier . This identifiers is of the category "OTHER".
  • Identifier: 0741701 . This is a "MEDICARE LEGACY" identifier . This identifiers is of the category "OTHER".
  • Identifier: 078845147 . This is a "CHAMPUS/TRICARE" identifier . This identifiers is of the category "OTHER".
  • Identifier: 612210600 . This is a "DOL" identifier . This identifiers is of the category "OTHER".
  • Identifier: 7100230780 , issued by the state of ( KY ) . This identifiers is of the category "MEDICAID".
  • Identifier: P00157716 . This is a "RAILROAD MEDICARE" identifier . This identifiers is of the category "OTHER".
  • Identifier: 64018096 , issued by the state of ( KY ) . This identifiers is of the category "MEDICAID".




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