Healthcare Provider Details

I. General information

NPI: 1639206576
Provider Name (Legal Business Name): LESLIE C. JENKINS ARRT, RPA
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/27/2007
Last Update Date: 05/06/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

503 N MAPLE ST STE 300
EFFINGHAM IL
62401-2006
US

IV. Provider business mailing address

15831 N 1400TH ST
EFFINGHAM IL
62401-5210
US

V. Phone/Fax

Practice location:
  • Phone: 217-340-1340
  • Fax:
Mailing address:
  • Phone: 720-427-3016
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code243U00000X
TaxonomyRadiology Practitioner Assistant
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: