Provider Demographics
NPI:1568760700
Name:5141, PA
Entity Type:Organization
Organization Name:5141, PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:KEVIN
Authorized Official - Last Name:KAUFMAN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:817-377-0143
Mailing Address - Street 1:501 W HARWOOD RD STE 100
Mailing Address - Street 2:
Mailing Address - City:HURST
Mailing Address - State:TX
Mailing Address - Zip Code:76054-3163
Mailing Address - Country:US
Mailing Address - Phone:817-377-0143
Mailing Address - Fax:817-377-0173
Practice Address - Street 1:501 W HARWOOD RD STE 100
Practice Address - Street 2:
Practice Address - City:HURST
Practice Address - State:TX
Practice Address - Zip Code:76054-3163
Practice Address - Country:US
Practice Address - Phone:817-377-0143
Practice Address - Fax:817-377-0173
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-03-12
Last Update Date:2023-06-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX207T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207T00000XAllopathic & Osteopathic PhysiciansNeurological SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX2826398-01Medicaid
TXTXB129475Medicare PIN