Basic Information
| Provider Information | |||||||||
| NPI: | 1598742371 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | SEIGFREID | ||||||||
| FirstName: | CHRISTOPHER | ||||||||
| MiddleName: | E | ||||||||
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| Credential: | CRNA | ||||||||
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| Mailing Information | |||||||||
| Address1: | DEPT 86236 | ||||||||
| Address2: | PO BOX 950195 | ||||||||
| City: | LOUISVILLE | ||||||||
| State: | KY | ||||||||
| PostalCode: | 402950001 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5024732127 | ||||||||
| FaxNumber: | 5026367950 | ||||||||
| Practice Location | |||||||||
| Address1: | 3 AUDUBON PLAZA DR | ||||||||
| Address2: | |||||||||
| City: | LOUISVILLE | ||||||||
| State: | KY | ||||||||
| PostalCode: | 402171319 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5026367449 | ||||||||
| FaxNumber: | 5026367950 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 12/22/2005 | ||||||||
| LastUpdateDate: | 10/11/2007 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 367500000X | 3615A | KY | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Anesthetist, Certified Registered |
ID Information
| ID | Type | State | Issuer | Description | 74003971 | 05 | KY | MEDICAID |