1780706523 NPI number — RANLEIGH LEWIS FLESHMAN

Table of content: RANLEIGH LEWIS FLESHMAN (NPI 1780706523)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1780706523 NPI number — RANLEIGH LEWIS FLESHMAN

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
FLESHMAN
Provider First Name:
RANLEIGH
Provider Middle Name:
LEWIS
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
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:
1780706523
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
05/06/2016
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 2375
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
WEST COLUMBIA
Provider Business Mailing Address State Name:
SC
Provider Business Mailing Address Postal Code:
29171-2375
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
803-936-8146
Provider Business Mailing Address Fax Number:
803-936-8916

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2720 SUNSET BLVD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
WEST COLUMBIA
Provider Business Practice Location Address State Name:
SC
Provider Business Practice Location Address Postal Code:
29169-4810
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
803-936-8146
Provider Business Practice Location Address Fax Number:
803-936-8916
Provider Enumeration Date:
04/04/2007

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: 207ZC0500X , with the licence number:  27987 , registered in the state of AL ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 009941960 , issued by the state of ( AL ) . This identifiers is of the category "MEDICAID".
  • Identifier: 009941961 , issued by the state of ( AL ) . This identifiers is of the category "MEDICAID".
  • Identifier: 051540286 . This is a "BLUE CROSS" identifier , issued by the state of ( AL ) . This identifiers is of the category "OTHER".
  • Identifier: 051540288 . This is a "BLUE CROSS" identifier , issued by the state of ( AL ) . This identifiers is of the category "OTHER".
  • Identifier: 009941959 , issued by the state of ( AL ) . This identifiers is of the category "MEDICAID".
  • Identifier: 051540287 . This is a "BLUE CROSS" identifier , issued by the state of ( AL ) . This identifiers is of the category "OTHER".




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