1619356607 NPI number — ENHANCED PRACTICE SERVICES

Table of content: JEROME STEPHEN LEONARD JR. MD, MPH (NPI 1922637677)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1619356607 NPI number — ENHANCED PRACTICE SERVICES

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
ENHANCED PRACTICE SERVICES
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:
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:
1619356607
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
07/21/2022
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
5908 COLUMBIA AVE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
HAMMOND
Provider Business Mailing Address State Name:
IN
Provider Business Mailing Address Postal Code:
46320-2610
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
219-803-7380
Provider Business Mailing Address Fax Number:
219-803-7551

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
5908 COLUMBIA AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
HAMMOND
Provider Business Practice Location Address State Name:
IN
Provider Business Practice Location Address Postal Code:
46320-2610
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
219-803-7380
Provider Business Practice Location Address Fax Number:
219-803-7551
Provider Enumeration Date:
05/22/2015

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
NEWELL
Authorized Official First Name:
ROBERT
Authorized Official Middle Name:
J.
Authorized Official Title or Position:
MEMBER
Authorized Official Telephone Number:
219-677-2269

Provider Taxonomy Codes

  • Taxonomy code: 2084N0400X , registered in the state of IN ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 207QS1201X , registered in the state of IN ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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