1245224310 NPI number — LEIGHTON V ARCENAS M.D.

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1245224310 NPI number — LEIGHTON V ARCENAS M.D.

Employer Identification Number (EIN):

Provider Organization Name:

Provider Last Name:

ARCENAS

Provider First Name:

LEIGHTON

Provider Middle Name:

V

Provider Name Prefix Text:

Provider Name Suffix Text:

Provider Credential Text:

M.D.

Provider Gender Code:

F

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:

1245224310

Entity Type Code:

Individual

Replacement NPI:

Last Update Date:

03/07/2023

NPI Deactivation Reason Code:

NPI Deactivation Date:

NPI Reactivation Date:

Provider First Line Business Mailing Address:

1228 E RUSHOLME ST

Provider Second Line Business Mailing Address:

COGENT OFFICE MOB I

Provider Business Mailing Address City Name:

DAVENPORT

Provider Business Mailing Address State Name:

IA

Provider Business Mailing Address Postal Code:

52803-2453

Provider Business Mailing Address Country Code:

US

Provider Business Mailing Address Telephone Number:

563-421-3122

Provider Business Mailing Address Fax Number:

Provider First Line Business Practice Location Address:

801 ILLINI DR

Provider Second Line Business Practice Location Address:

Provider Business Practice Location Address City Name:

SILVIS

Provider Business Practice Location Address State Name:

IL

Provider Business Practice Location Address Postal Code:

61282-1804

Provider Business Practice Location Address Country Code:

US

Provider Business Practice Location Address Telephone Number:

309-792-9363

Provider Business Practice Location Address Fax Number:

Provider Enumeration Date:

09/06/2005

Authorized Official Last Name:

Authorized Official First Name:

Authorized Official Middle Name:

Authorized Official Title or Position:

Authorized Official Telephone Number:

• Taxonomy code: 207R00000X , with the licence number:  27859 , registered in the state of IA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
• Taxonomy code: 207R00000X , with the licence number: 036-066279 , registered in the state of IL ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

• Identifier: IL1240005 . This is a "ILLINOIS MEDICARE" identifier , issued by the state of ( IL ) . This identifiers is of the category "OTHER".
• Identifier: 421060724002 , issued by the state of ( IL ) . This identifiers is of the category "MEDICAID".
• Identifier: 8122859 . This is a "ILLINOIS BC/BS" identifier , issued by the state of ( IL ) . This identifiers is of the category "OTHER".
• Identifier: 0080200 , issued by the state of ( IA ) . This identifiers is of the category "MEDICAID".
• Identifier: 019489 . This is a "IOWA BC/BS" identifier , issued by the state of ( IA ) . This identifiers is of the category "OTHER".
• Identifier: 1234733 . This is a "CONTROLLED SUBSTANCE #" identifier , issued by the state of ( IA ) . This identifiers is of the category "OTHER".
• Identifier: 42106072439 . This is a "JOHN DEERE HEALTH" identifier , issued by the state of ( IA ) . This identifiers is of the category "OTHER".
• Identifier: IA0139 . This is a "JOHN DEERE EDI #" identifier , issued by the state of ( IA ) . This identifiers is of the category "OTHER".
• Identifier: 067240 . This is a "HEALTH ALLIANCE #" identifier , issued by the state of ( IA ) . This identifiers is of the category "OTHER".