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NPI Code Detail

MEDICARE: JEFFREY L LEACH CRNA

MEDICARE: JEFFREY L LEACH CRNA
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1207L00000XAnesthesiology PhysicianRN-136249OH

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2000000024058OTHEROHANTHEM PIN

General Provider Information

NPI Number : 1083610406
Entity Type Code : Individual
Provider Name (Legal Business Name) : JEFFREY L LEACH CRNA
Provider Business Mailing Address
First Line : 3001 MAYAPPLE DR
Second Line :
City : HUDSON
State : OH
Zip : 44236-2452
Country : US
Telephone Number : 330-315-8398
Fax Number :
Provider Business Practice Location Address
First Line : 832 S MAIN ST
Second Line :
City : ORRVILLE
State : OH
Zip : 44667-2208
Country : US
Telephone Number : 330-682-3010
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 06/21/2005
Last Update Date : 07/09/2007

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Directions to “ JEFFREY L LEACH CRNA” Practice Location

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