1609086834 NPI number — LESLIE ORTHOPEDICS AND SPORTS MEDICINE INC

Table of content: (NPI 1609086834)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1609086834 NPI number — LESLIE ORTHOPEDICS AND SPORTS MEDICINE INC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
LESLIE ORTHOPEDICS AND SPORTS MEDICINE 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:
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:
1609086834
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
02/08/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
226 E US HIGHWAY 54
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
CAMDENTON
Provider Business Mailing Address State Name:
MO
Provider Business Mailing Address Postal Code:
65020-6819
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
573-346-3700
Provider Business Mailing Address Fax Number:
573-346-3307

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
226 E US HIGHWAY 54
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
CAMDENTON
Provider Business Practice Location Address State Name:
MO
Provider Business Practice Location Address Postal Code:
65020-6819
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
573-346-3700
Provider Business Practice Location Address Fax Number:
573-346-3307
Provider Enumeration Date:
05/23/2007

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
BRUCE
Authorized Official First Name:
ROBERT
Authorized Official Middle Name:
JOE
Authorized Official Title or Position:
OFFICE MANAGER
Authorized Official Telephone Number:
573-346-3700

Provider Taxonomy Codes

  • Taxonomy code: 207XP3100X , with the licence number:  RP344 , registered in the state of MO ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 1922012772 . This is a "CHRIS LESLIE, D.O." identifier , issued by the state of ( MO ) . This identifiers is of the category "OTHER".
  • Identifier: 1023031762 . This is a "BRIAN D. SWANSON" identifier , issued by the state of ( MO ) . This identifiers is of the category "OTHER".