1790759371 NPI number — DR. LESLEE IONE BALL-SCOVEL MD

Table of content: DR. LESLEE IONE BALL-SCOVEL MD (NPI 1790759371)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1790759371 NPI number — DR. LESLEE IONE BALL-SCOVEL MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
BALL-SCOVEL
Provider First Name:
LESLEE
Provider Middle Name:
IONE
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
MD
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:
1790759371
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
09/18/2024
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
THE VILLAGES VA OUTPATIENT CLINIC
Provider Second Line Business Mailing Address:
8900 SE 165TH MULBERRY LN
Provider Business Mailing Address City Name:
THE VILLAGES
Provider Business Mailing Address State Name:
FL
Provider Business Mailing Address Postal Code:
32162-2040
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
352-674-5000
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
415 EMBASSY OAKS
Provider Second Line Business Practice Location Address:
STE 200
Provider Business Practice Location Address City Name:
SAN ANTONIO
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
78216-2040
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
210-490-9087
Provider Business Practice Location Address Fax Number:
210-490-9111
Provider Enumeration Date:
02/13/2006

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: 207R00000X , with the licence number:  119491 , registered in the state of MO ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 207R00000X , with the licence number: M6035 , registered in the state of TX ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: TXB126928 . This is a "WELLMED MEDICAL GROUP PA" identifier . This identifiers is of the category "OTHER".




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