1306899315 NPI number — LEISURE SOLUTIONS, INC.

Table of content: (NPI 1306899315)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1306899315 NPI number — LEISURE SOLUTIONS, INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
LEISURE SOLUTIONS, INC.
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
6
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:
1306899315
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
04/20/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
13940 N US HIGHWAY 441
Provider Second Line Business Mailing Address:
SUITE 905
Provider Business Mailing Address City Name:
LADY LAKE
Provider Business Mailing Address State Name:
FL
Provider Business Mailing Address Postal Code:
32159-8908
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
352-751-0235
Provider Business Mailing Address Fax Number:
352-751-6777

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
13940 N US HIGHWAY 441
Provider Second Line Business Practice Location Address:
SUITE 905
Provider Business Practice Location Address City Name:
LADY LAKE
Provider Business Practice Location Address State Name:
FL
Provider Business Practice Location Address Postal Code:
32159-8908
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
352-751-0235
Provider Business Practice Location Address Fax Number:
352-751-6777
Provider Enumeration Date:
05/19/2006

Additional Information

Authorized Official

Authorized Official Last Name:
RAPHAEL
Authorized Official First Name:
JACQUES
Authorized Official Middle Name:
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
352-751-0235

Provider Taxonomy Codes

  • Taxonomy code: 291U00000X , with the licence number:  HCC5021 , registered in the state of FL ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 2230264 . This is a "FIRST HEALTH" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".
  • Identifier: 278869 . This is a "HEALTHEASE" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".
  • Identifier: F01321 . This is a "FREEDOM HEALTH" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".
  • Identifier: 05641 . This is a "UNITED HEALTH CARE" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".
  • Identifier: 06541 . This is a "UNIVERSAL HEALTHCARE" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".
  • Identifier: 3679125 . This is a "AETNA HMO" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".
  • Identifier: 7936611 . This is a "AETNA PPO" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".
  • Identifier: V2891 . This is a "BCBS" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".




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