1871704965 NPI number — MS. DINA B LEIGHTON L.O.T.R.

Table of content: MS. DINA B LEIGHTON L.O.T.R. (NPI 1871704965)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1871704965 NPI number — MS. DINA B LEIGHTON L.O.T.R.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
LEIGHTON
Provider First Name:
DINA
Provider Middle Name:
B
Provider Name Prefix Text:
MS.
Provider Name Suffix Text:
Provider Credential Text:
L.O.T.R.
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:
1871704965
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
03/11/2016
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 13251
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
ALEXANDRIA
Provider Business Mailing Address State Name:
LA
Provider Business Mailing Address Postal Code:
71315-3251
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
318-730-3632
Provider Business Mailing Address Fax Number:
318-487-0417

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1140 COLLEGE AVE LC COLLEGE POOL
Provider Second Line Business Practice Location Address:
C/O PE DEPT DR SPEARS
Provider Business Practice Location Address City Name:
PINEVILLE
Provider Business Practice Location Address State Name:
LA
Provider Business Practice Location Address Postal Code:
71359
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
318-730-3632
Provider Business Practice Location Address Fax Number:
318-487-0417
Provider Enumeration Date:
05/24/2007

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: 225XN1300X , with the licence number:  Z11380 , registered in the state of LA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 225400000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

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

  • Identifier: OTT211380 . This is a "OFFICE OF GROUP BENEFITS OF LA" identifier , issued by the state of ( LA ) . This identifiers is of the category "OTHER".




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