1780874420 NPI number — MRS. LESLIE ELIAS CHENEY R.PH.

Table of content: MRS. LESLIE ELIAS CHENEY R.PH. (NPI 1780874420)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1780874420 NPI number — MRS. LESLIE ELIAS CHENEY R.PH.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
CHENEY
Provider First Name:
LESLIE
Provider Middle Name:
ELIAS
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
R.PH.
Provider Gender Code:
F

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:
1780874420
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/30/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
569 LAKE COLONY DR
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
BIRMINGHAM
Provider Business Mailing Address State Name:
AL
Provider Business Mailing Address Postal Code:
35242-7409
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
205-967-3006
Provider Business Mailing Address Fax Number:
205-967-3006

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1936 OLD ORCHARD ROAD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
BIRMINGHAM
Provider Business Practice Location Address State Name:
AL
Provider Business Practice Location Address Postal Code:
35216-2247
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
205-824-0775
Provider Business Practice Location Address Fax Number:
205-313-5791
Provider Enumeration Date:
07/30/2007

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: 183500000X , with the licence number:  14543 , 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)





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