MEDICARE: ELDON LESTER LEINWEBER PA-C

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
1	363A00000X	Physician Assistant	PA10004217	WA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	211648	OTHER	WA	LABOR & INDUSTRIES ID #
3	6612LE	OTHER	WA	REGENCE PROVIDER #
4	0193143	OTHER	WA	LABOR &INDUSTRIES ID #
5	1051425	OTHER	WA	NCCPA CERTIFICATION

General Provider Information

NPI Number	:	1730148958
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ELDON LESTER LEINWEBER PA-C

Provider Business Mailing Address
First Line	:	PO BOX 1050
Second Line	:
City	:	SOAP LAKE
State	:	WA
Zip	:	98851-1050
Country	:	US
Telephone Number	:	509-888-9606
Fax Number	:	509-683-1135

Provider Business Practice Location Address
First Line	:	22 WEST HIGHWAY 28
Second Line	:
City	:	SOAP LAKE
State	:	WA
Zip	:	98851
Country	:	US
Telephone Number	:	509-888-9606
Fax Number	:	509-683-1135

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/17/2006
Last Update Date	:	03/07/2023

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