1598719890 NPI number — JOSEPH R. LEITH MD

Table of content: (NPI 1629438015)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1598719890 NPI number — JOSEPH R. LEITH MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
LEITH
Provider First Name:
JOSEPH
Provider Middle Name:
R.
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
MD
Provider Gender Code:
M

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:
1598719890
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
12/21/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1735 27TH ST STE B06
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
PORTSMOUTH
Provider Business Mailing Address State Name:
OH
Provider Business Mailing Address Postal Code:
45662-2681
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
740-356-8681
Provider Business Mailing Address Fax Number:
740-353-7900

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
8770 OHIO RIVER RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
WHEELERSBURG
Provider Business Practice Location Address State Name:
OH
Provider Business Practice Location Address Postal Code:
45694-1918
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
740-574-9090
Provider Business Practice Location Address Fax Number:
740-356-4180
Provider Enumeration Date:
05/20/2006

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: 207X00000X , with the licence number:  40139 , registered in the state of KY ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 207X00000X , with the licence number: 35-083254 , registered in the state of OH ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 40139 . This is a "KENTUCKY MEDICAL LICENSE" identifier , issued by the state of ( KY ) . This identifiers is of the category "OTHER".
  • Identifier: 505145374-00 . This is a "BWC" identifier , issued by the state of ( OH ) . This identifiers is of the category "OTHER".
  • Identifier: 2636893 , issued by the state of ( OH ) . This identifiers is of the category "MEDICAID".
  • Identifier: 205145374027 . This is a "CARESOURCE" identifier . This identifiers is of the category "OTHER".
  • Identifier: 613050500 . This is a "DEPARTMENT OF LABOR" identifier , issued by the state of ( KY ) . This identifiers is of the category "OTHER".
  • Identifier: 7207794 . This is a "AETNA" identifier . This identifiers is of the category "OTHER".
  • Identifier: 00000501050 . This is a "ANTHEM" identifier . This identifiers is of the category "OTHER".
  • Identifier: 64126303 , issued by the state of ( KY ) . This identifiers is of the category "MEDICAID".
  • Identifier: P00401805 . This is a "RAILROAD MEDICARE" identifier , issued by the state of ( KY ) . This identifiers is of the category "OTHER".




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