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NPI Code Detail

MEDICARE: JEREMY DAVID LEIST

MEDICARE: JEREMY DAVID LEIST
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
1171M00000XCase Manager/Care Coordinator

Other Identifiers

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

General Provider Information

NPI Number : 1144189838
Entity Type Code : Individual
Provider Name (Legal Business Name) : JEREMY DAVID LEIST
Provider Business Mailing Address
First Line : 135 GREEN VALLEY DR
Second Line :
City : ENON
State : OH
Zip : 45323-1121
Country : US
Telephone Number : 937-215-3974
Fax Number :
Provider Business Practice Location Address
First Line : 10400 BLACKLICK EASTERN RD
Second Line :
City : PICKERINGTON
State : OH
Zip : 43147-8235
Country : US
Telephone Number : 614-726-7359
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 01/19/2026
Last Update Date : 01/19/2026

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