1265511315 NPI number — LESLEY P ABBOTT D.O.

Table of content: LESLEY P ABBOTT D.O. (NPI 1265511315)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1265511315 NPI number — LESLEY P ABBOTT D.O.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
ABBOTT
Provider First Name:
LESLEY
Provider Middle Name:
P
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
D.O.
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1265511315
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
02/09/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
524 SUNSET DROVE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
ASHLAND
Provider Business Mailing Address State Name:
KY
Provider Business Mailing Address Postal Code:
41101-2681
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
606-232-9179
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2121 ARGILLITE RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
FLATWOODS
Provider Business Practice Location Address State Name:
KY
Provider Business Practice Location Address Postal Code:
41139-2615
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
606-833-1111
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
11/02/2006

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: 207Q00000X , with the licence number:  02808 , registered in the state of KY ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 207Q00000X , with the licence number: KY020803 , registered in the state of KY ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 01-13293 . This is a "CHA PIN" identifier , issued by the state of ( KY ) . This identifiers is of the category "OTHER".
  • Identifier: P00157257 . This is a "RAILROAD MEDICARE PIN" identifier , issued by the state of ( KY ) . This identifiers is of the category "OTHER".
  • Identifier: 000000339034 . This is a "BLUE CROSS SHIELD PIN" identifier , issued by the state of ( KY ) . This identifiers is of the category "OTHER".
  • Identifier: 000000606035 . This is a "ANTHEM BCBS" identifier , issued by the state of ( KY ) . This identifiers is of the category "OTHER".
  • Identifier: 2509084 , issued by the state of ( OH ) . This identifiers is of the category "MEDICAID".
  • Identifier: 64081524 , issued by the state of ( KY ) . This identifiers is of the category "MEDICAID".




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