MEDICARE: KENNETH S WEISS M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207X00000X	Orthopaedic Surgery Physician	34880	TN
2	207XX0005X	Sports Medicine (Orthopaedic Surgery) Physician	34880	TN

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
13	200041126	OTHER	TN	RAILROAD MEDICARE

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3	3881110	OTHER	TN	CIGNA
4	620819926	OTHER	MS	BCBS
5	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
6	4014940	OTHER	TN	BCBS
7	620819926	OTHER	TN	AETNA
8	620819926	OTHER	TN	CIGNA
9	620819926	OTHER	TN	TRICARE
10	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
11	7146128	OTHER	TN	AETNA
12	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
14	40106	OTHER	UT	TLC
15	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1700889730
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KENNETH S WEISS M.D.

Provider Business Mailing Address
First Line	:	6077 PRIMACY PKWY STE 140
Second Line	:
City	:	MEMPHIS
State	:	TN
Zip	:	38119-5742
Country	:	US
Telephone Number	:	901-641-3000
Fax Number	:	901-701-2400

Provider Business Practice Location Address
First Line	:	6286 BRIARCREST AVE STE 200
Second Line	:
City	:	MEMPHIS
State	:	TN
Zip	:	38120-4023
Country	:	US
Telephone Number	:	901-641-3000
Fax Number	:	901-701-2400

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/23/2005
Last Update Date	:	03/16/2021

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Directions to “ KENNETH S WEISS M.D.” Practice Location

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