Basic Information
Provider Information | |||||||||
NPI: | 1891724738 | ||||||||
EntityType: | 1 | ||||||||
ReplacementNPI: |   | ||||||||
OrganizationName: |   | ||||||||
LastName: | KAUFMAN | ||||||||
FirstName: | SETH | ||||||||
MiddleName: | I | ||||||||
NamePrefix: |   | ||||||||
NameSuffix: |   | ||||||||
Credential: | MD | ||||||||
OtherOrganizationName: |   | ||||||||
OtherOrganizationType: |   | ||||||||
OtherLastName: |   | ||||||||
OtherFirstName: |   | ||||||||
OtherMiddleName: |   | ||||||||
OtherNamePrefix: |   | ||||||||
OtherNameSuffix: |   | ||||||||
OtherCredential: |   | ||||||||
OtherLastNameType: |   | ||||||||
Mailing Information | |||||||||
Address1: | 100 N HUMPHREYS BLVD | ||||||||
Address2: |   | ||||||||
City: | MEMPHIS | ||||||||
State: | TN | ||||||||
PostalCode: | 381202146 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 9016830055 | ||||||||
FaxNumber: | 9016859718 | ||||||||
Practice Location | |||||||||
Address1: | 100 N HUMPHREYS BLVD | ||||||||
Address2: |   | ||||||||
City: | MEMPHIS | ||||||||
State: | TN | ||||||||
PostalCode: | 381202146 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 9016830055 | ||||||||
FaxNumber: | 9016859718 | ||||||||
Other Information | |||||||||
ProviderEnumerationDate: | 07/02/2006 | ||||||||
LastUpdateDate: | 05/14/2021 | ||||||||
NPIDeactivationReasonCode: |   | ||||||||
NPIDeactivationDate: |   | ||||||||
NPIReactivationDate: |   | ||||||||
ProviderGenderCode: | M | ||||||||
AuthorizedOfficialLastName: |   | ||||||||
AuthorizedOfficialFirstName: |   | ||||||||
AuthorizedOfficialMiddleName: |   | ||||||||
AuthorizedOfficialTitleorPosition: |   | ||||||||
AuthorizedOfficialTelephone: |   | ||||||||
IsSoleProprietor: | N | ||||||||
IsOrganizationSubpart: |   | ||||||||
ParentOrganizationLBN: |   | ||||||||
AuthorizedOfficialNamePrefix: |   | ||||||||
AuthorizedOfficialNameSuffix: |   | ||||||||
AuthorizedOfficialCredential: |   | ||||||||
NPICertificationDate: | 05/14/2021 |
Taxonomy Information
Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 208VP0000X | 17581 | TN | N |   | Allopathic & Osteopathic Physicians | Pain Medicine | Pain Medicine | 208VP0000X | 11868 | MS | N |   | Allopathic & Osteopathic Physicians | Pain Medicine | Pain Medicine | 207LA0401X | 17581 | TN | Y |   | Allopathic & Osteopathic Physicians | Anesthesiology | Addiction Medicine |
ID Information
ID | Type | State | Issuer | Description | 07830832 | 05 | MS |   | MEDICAID | 3028135 | 05 | TN |   | MEDICAID | 1592714 | 05 | LA |   | MEDICAID | 4062326 | 01 | TN | AETNA | OTHER | 125756001 | 05 | AR |   | MEDICAID | 208798009 | 05 | MO |   | MEDICAID | 4048883 | 01 | TN | BCBS TN | OTHER | 90087 | 01 | AR | BCBS AR | OTHER |