1912149261 NPI number — DR. JOHN D LEEVER DO

Table of content: DR. JOHN D LEEVER DO (NPI 1912149261)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1912149261 NPI number — DR. JOHN D LEEVER DO

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
LEEVER
Provider First Name:
JOHN
Provider Middle Name:
D
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
DO
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:
1912149261
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
09/17/2019
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 308
Provider Second Line Business Mailing Address:
BUSINESS OPTIONS MEDICAL BILLING
Provider Business Mailing Address City Name:
MONTROSE
Provider Business Mailing Address State Name:
CO
Provider Business Mailing Address Postal Code:
81402-0308
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
970-765-0818
Provider Business Mailing Address Fax Number:
970-497-8410

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2373 G. ROAD, SUITE 140
Provider Second Line Business Practice Location Address:
CANYON VIEW MEDICAL PLAZA
Provider Business Practice Location Address City Name:
GRAND JUNCTION
Provider Business Practice Location Address State Name:
CO
Provider Business Practice Location Address Postal Code:
81505
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
970-644-4345
Provider Business Practice Location Address Fax Number:
970-644-4379
Provider Enumeration Date:
04/01/2009

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:  5333 , registered in the state of OK ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 2085R0202X , with the licence number: 5101019686 , registered in the state of MI ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 2085R0202X , with the licence number: DR.0056205 , registered in the state of CO ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 48780065 , issued by the state of ( CO ) . This identifiers is of the category "MEDICAID".
  • Identifier: 1912149261 , issued by the state of ( MI ) . This identifiers is of the category "MEDICAID".
  • Identifier: P01608010 . This is a "RAILROAD WORKERS MEDICARE PTAN FOR DIAGNOSTIC RADIOLOGY ASSOCIATES" identifier , issued by the state of ( CO ) . This identifiers is of the category "OTHER".




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