1174630180 NPI number — MRS. LEANNE R. COTA PA-C

Table of content: MRS. LEANNE R. COTA PA-C (NPI 1174630180)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1174630180 NPI number — MRS. LEANNE R. COTA PA-C

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
COTA
Provider First Name:
LEANNE
Provider Middle Name:
R.
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
PA-C
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
BREIHAHN
Provider Other First Name:
LEANNE
Provider Other Middle Name:
R.
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
PA-C
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1174630180
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
06/17/2021
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 4
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
PLEVNA
Provider Business Mailing Address State Name:
MT
Provider Business Mailing Address Postal Code:
59344-0004
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
406-778-7750
Provider Business Mailing Address Fax Number:
406-772-5849

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
150 FRONT ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
TANANA
Provider Business Practice Location Address State Name:
AK
Provider Business Practice Location Address Postal Code:
99777
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
907-366-7222
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
08/24/2006

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: 363A00000X , with the licence number:  36234 , registered in the state of MT ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 363A00000X , with the licence number: PA0000001325 , registered in the state of TN ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 363A00000X , with the licence number: 170876 , registered in the state of AK ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 170876 . This is a "ALASKA MEDICAL LICENSE" identifier , issued by the state of ( AK ) . This identifiers is of the category "OTHER".
  • Identifier: MEDPACLIC36234 . This is a "MONTANA MEDICAL LICENSE" identifier , issued by the state of ( MT ) . This identifiers is of the category "OTHER".
  • Identifier: PA0000001325 . This is a "MEDICAL LICENSE NUMBER" identifier , issued by the state of ( TN ) . This identifiers is of the category "OTHER".




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