1912149733 NPI number — CHARLES D. LEFLER M.D. ,P.A

Table of content: (NPI 1912149733)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1912149733 NPI number — CHARLES D. LEFLER M.D. ,P.A

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
CHARLES D. LEFLER M.D. ,P.A
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

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 Information

NPI Number:
1912149733
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
11/17/2009
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 1689
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
ETOWAH
Provider Business Mailing Address State Name:
NC
Provider Business Mailing Address Postal Code:
28729-1689
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
828-891-5524
Provider Business Mailing Address Fax Number:
828-891-4069

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
89 MEDICAL PARK DR
Provider Second Line Business Practice Location Address:
STE A
Provider Business Practice Location Address City Name:
BREVARD
Provider Business Practice Location Address State Name:
NC
Provider Business Practice Location Address Postal Code:
28712-3035
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
828-884-4134
Provider Business Practice Location Address Fax Number:
828-884-6665
Provider Enumeration Date:
03/25/2009

Additional Information

Authorized Official

Authorized Official Last Name:
LEFLER
Authorized Official First Name:
CHARLES
Authorized Official Middle Name:
D
Authorized Official Title or Position:
M.D. / OWNER
Authorized Official Telephone Number:
828-884-4134

Provider Taxonomy Codes

  • Taxonomy code: 207R00000X , with the licence number:  16898 , registered in the state of NC ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 51592 . This is a "BCBS" identifier , issued by the state of ( NC ) . This identifiers is of the category "OTHER".
  • Identifier: 5911937 , issued by the state of ( NC ) . This identifiers is of the category "MEDICAID".




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