1356394084 NPI number — DR. AGNES C. KAUFMAN DC

Table of content: MEERA SINGH (NPI 1871381715)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1356394084 NPI number — DR. AGNES C. KAUFMAN DC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
KAUFMAN
Provider First Name:
AGNES
Provider Middle Name:
C.
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
DC
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
BARBOZA
Provider Other First Name:
AGNES
Provider Other Middle Name:
C
Provider Other Name Prefix Text:
DR.
Provider Other Name Suffix Text:
Provider Other Credential Text:
DC
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1356394084
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
03/24/2017
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
125 BLUE HERON DR
Provider Second Line Business Mailing Address:
SUITE B
Provider Business Mailing Address City Name:
MONTGOMERY
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
77316-3183
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
936-582-0404
Provider Business Mailing Address Fax Number:
936-582-0410

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
125 BLUE HERON DR
Provider Second Line Business Practice Location Address:
SUITE B
Provider Business Practice Location Address City Name:
MONTGOMERY
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
77316-3183
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
936-582-0404
Provider Business Practice Location Address Fax Number:
936-582-0410
Provider Enumeration Date:
05/17/2006

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: 111N00000X , with the licence number:  12577 , registered in the state of TX ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 0921417 , issued by the state of ( OH ) . This identifiers is of the category "MEDICAID".
  • Identifier: 000000382250 . This is a "ANTHEM" identifier , issued by the state of ( OH ) . This identifiers is of the category "OTHER".
  • Identifier: 05397 . This is a "PARAMOUNT" identifier , issued by the state of ( OH ) . This identifiers is of the category "OTHER".
  • Identifier: 735038 . This is a "BUCKEYE" identifier , issued by the state of ( OH ) . This identifiers is of the category "OTHER".
  • Identifier: P00293886 . This is a "RAILROAD MEDICARE" identifier , issued by the state of ( OH ) . This identifiers is of the category "OTHER".




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