1316058894 NPI number — JOSEPH SCOTT LEITHOLD MD

Table of content: MS. SHARON BOND-LOVING LCSW (NPI 1295253623)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1316058894 NPI number — JOSEPH SCOTT LEITHOLD MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
LEITHOLD
Provider First Name:
JOSEPH
Provider Middle Name:
SCOTT
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:
1316058894
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/01/2014
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
4235 INDIAN RIPPLE ROAD
Provider Second Line Business Mailing Address:
STE 210
Provider Business Mailing Address City Name:
BEAVERCREEK
Provider Business Mailing Address State Name:
OH
Provider Business Mailing Address Postal Code:
45440
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
937-427-9202
Provider Business Mailing Address Fax Number:
937-427-9671

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
4235 INDIAN RIPPLE ROAD
Provider Second Line Business Practice Location Address:
STE 210
Provider Business Practice Location Address City Name:
BEAVERCREEK
Provider Business Practice Location Address State Name:
OH
Provider Business Practice Location Address Postal Code:
45440
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
937-427-9202
Provider Business Practice Location Address Fax Number:
937-427-9671
Provider Enumeration Date:
08/31/2006

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: 207Q00000X , with the licence number:  35070285 , 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: D70285 . This is a "CHOICE CARE" identifier . This identifiers is of the category "OTHER".
  • Identifier: OC04048 . This is a "NATIONWIDE" identifier . This identifiers is of the category "OTHER".
  • Identifier: 00000012299Z . This is a "ANTHEM" identifier . This identifiers is of the category "OTHER".
  • Identifier: DB1884 . This is a "MEDICARE PALMETTO GBA" identifier , issued by the state of ( OH ) . This identifiers is of the category "OTHER".
  • Identifier: 0248397 , issued by the state of ( OH ) . This identifiers is of the category "MEDICAID".
  • Identifier: 311715256001 . This is a "TRICARE" identifier . This identifiers is of the category "OTHER".
  • Identifier: 080162406 . This is a "MEDICARE RAILROAD" identifier , issued by the state of ( OH ) . This identifiers is of the category "OTHER".
  • Identifier: 311715256026 . This is a "CARESOURCE" identifier . This identifiers is of the category "OTHER".
  • Identifier: 0122804 . This is a "UNITED HEALTH CARE" identifier . This identifiers is of the category "OTHER".




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