1225073372 NPI number — MS. LEAH MARIE NAGUIT BENGCO P.T.

Table of content: TENIA HOLLOWAY (NPI 1518435999)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1225073372 NPI number — MS. LEAH MARIE NAGUIT BENGCO P.T.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
BENGCO
Provider First Name:
LEAH MARIE
Provider Middle Name:
NAGUIT
Provider Name Prefix Text:
MS.
Provider Name Suffix Text:
Provider Credential Text:
P.T.
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
BENGCO
Provider Other First Name:
LEAH
Provider Other Middle Name:
MARIE
Provider Other Name Prefix Text:
MS.
Provider Other Name Suffix Text:
Provider Other Credential Text:
P.T.
Provider Other Last Name Type Code:
5

NPI Number Information

NPI Number:
1225073372
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
04/22/2015
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
901 E MORRIS BLVD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
MORRISTOWN
Provider Business Mailing Address State Name:
TN
Provider Business Mailing Address Postal Code:
37813-2499
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
423-586-6866
Provider Business Mailing Address Fax Number:
423-581-9679

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
901 E MORRIS BLVD
Provider Second Line Business Practice Location Address:
SUITE E
Provider Business Practice Location Address City Name:
MORRISTOWN
Provider Business Practice Location Address State Name:
TN
Provider Business Practice Location Address Postal Code:
37813-2499
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
423-586-6866
Provider Business Practice Location Address Fax Number:
423-581-9679
Provider Enumeration Date:
06/20/2006

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: 225100000X , with the licence number:  6945 , registered in the state of TN ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 4117977 . This is a "BCBS /BC PROVIDER" identifier , issued by the state of ( TN ) . This identifiers is of the category "OTHER".
  • Identifier: 621773663 . This is a "GROUP TAX ID" identifier , issued by the state of ( TN ) . This identifiers is of the category "OTHER".
  • Identifier: 7404443 . This is a "AETNA GROUP PROV. #" identifier , issued by the state of ( TN ) . This identifiers is of the category "OTHER".
  • Identifier: 1364074 . This is a "CIGNA GROUP PROV.#" identifier , issued by the state of ( TN ) . This identifiers is of the category "OTHER".




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