1124060637 NPI number — LEDER INTERNAL MEDICINE ASSOCIATES PC

Table of content: (NPI 1124060637)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1124060637 NPI number — LEDER INTERNAL MEDICINE ASSOCIATES PC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
LEDER INTERNAL MEDICINE ASSOCIATES PC
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:
1124060637
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
10/31/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
3464 S WILLOW ST
Provider Second Line Business Mailing Address:
SUITE 166
Provider Business Mailing Address City Name:
DENVER
Provider Business Mailing Address State Name:
CO
Provider Business Mailing Address Postal Code:
80231-4531
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
303-755-2900
Provider Business Mailing Address Fax Number:
303-755-0404

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1325 S COLORADO BLVD
Provider Second Line Business Practice Location Address:
SUITE B306
Provider Business Practice Location Address City Name:
DENVER
Provider Business Practice Location Address State Name:
CO
Provider Business Practice Location Address Postal Code:
80222-3303
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
303-759-2985
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
06/11/2006

Additional Information

Authorized Official

Authorized Official Last Name:
LEDER
Authorized Official First Name:
ERIC
Authorized Official Middle Name:
H
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
303-759-2985

Provider Taxonomy Codes

  • Taxonomy code: 207R00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 04112041 , issued by the state of ( CO ) . This identifiers is of the category "MEDICAID".
  • Identifier: LE11204 . This is a "BLUE SHIELD" identifier , issued by the state of ( CO ) . This identifiers is of the category "OTHER".
  • Identifier: CS2534 . This is a "RAILROAD MEDICARE" identifier , issued by the state of ( CO ) . This identifiers is of the category "OTHER".




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