1659373546 NPI number — CARL E LEY MD

Table of content: CARL E LEY MD (NPI 1659373546)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1659373546 NPI number — CARL E LEY MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
LEY
Provider First Name:
CARL
Provider Middle Name:
E
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:
1659373546
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
04/08/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 1829
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
COEUR D ALENE
Provider Business Mailing Address State Name:
ID
Provider Business Mailing Address Postal Code:
83816-1829
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
208-667-9334
Provider Business Mailing Address Fax Number:
208-664-2341

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
700 W IRONWOOD DR
Provider Second Line Business Practice Location Address:
SUITE 110
Provider Business Practice Location Address City Name:
COEUR D ALENE
Provider Business Practice Location Address State Name:
ID
Provider Business Practice Location Address Postal Code:
83814-2656
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
208-666-3200
Provider Business Practice Location Address Fax Number:
208-666-3217
Provider Enumeration Date:
08/11/2005

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: 2085R0202X , with the licence number:  M5434 , registered in the state of ID ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 8136269 , issued by the state of ( WA ) . This identifiers is of the category "MEDICAID".
  • Identifier: D8728 . This is a "BC ID - CDA" identifier , issued by the state of ( ID ) . This identifiers is of the category "OTHER".
  • Identifier: 54346 . This is a "BC ID - RANI" identifier , issued by the state of ( ID ) . This identifiers is of the category "OTHER".
  • Identifier: P00093831 . This is a "RR MEDICARE - RANI" identifier , issued by the state of ( ID ) . This identifiers is of the category "OTHER".
  • Identifier: 1121411 . This is a "CIGNA MEDICARE - RANI" identifier , issued by the state of ( ID ) . This identifiers is of the category "OTHER".
  • Identifier: B1287 . This is a "BC ID - PF" identifier , issued by the state of ( ID ) . This identifiers is of the category "OTHER".




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