1245224310 NPI number — LEIGHTON V ARCENAS M.D.

Table of content: LEIGHTON V ARCENAS M.D. (NPI 1245224310)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1245224310 NPI number — LEIGHTON V ARCENAS M.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
ARCENAS
Provider First Name:
LEIGHTON
Provider Middle Name:
V
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
M.D.
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:
1245224310
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
03/07/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1228 E RUSHOLME ST
Provider Second Line Business Mailing Address:
COGENT OFFICE MOB I
Provider Business Mailing Address City Name:
DAVENPORT
Provider Business Mailing Address State Name:
IA
Provider Business Mailing Address Postal Code:
52803-2453
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
563-421-3122
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
801 ILLINI DR
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
SILVIS
Provider Business Practice Location Address State Name:
IL
Provider Business Practice Location Address Postal Code:
61282-1804
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
309-792-9363
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
09/06/2005

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: 207R00000X , with the licence number:  27859 , registered in the state of IA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 207R00000X , with the licence number: 036-066279 , registered in the state of IL ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

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

  • Identifier: IL1240005 . This is a "ILLINOIS MEDICARE" identifier , issued by the state of ( IL ) . This identifiers is of the category "OTHER".
  • Identifier: 421060724002 , issued by the state of ( IL ) . This identifiers is of the category "MEDICAID".
  • Identifier: 8122859 . This is a "ILLINOIS BC/BS" identifier , issued by the state of ( IL ) . This identifiers is of the category "OTHER".
  • Identifier: 0080200 , issued by the state of ( IA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 019489 . This is a "IOWA BC/BS" identifier , issued by the state of ( IA ) . This identifiers is of the category "OTHER".
  • Identifier: 1234733 . This is a "CONTROLLED SUBSTANCE #" identifier , issued by the state of ( IA ) . This identifiers is of the category "OTHER".
  • Identifier: 42106072439 . This is a "JOHN DEERE HEALTH" identifier , issued by the state of ( IA ) . This identifiers is of the category "OTHER".
  • Identifier: IA0139 . This is a "JOHN DEERE EDI #" identifier , issued by the state of ( IA ) . This identifiers is of the category "OTHER".
  • Identifier: 067240 . This is a "HEALTH ALLIANCE #" identifier , issued by the state of ( IA ) . This identifiers is of the category "OTHER".