Basic Information
| Provider Information | |||||||||
| NPI: | 1356853691 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | LEADING HEALTHCARE, PLLC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 13555 W MCDOWELL RD STE 205 | ||||||||
| Address2: | |||||||||
| City: | GOODYEAR | ||||||||
| State: | AZ | ||||||||
| PostalCode: | 853952626 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6232951190 | ||||||||
| FaxNumber: | 6024298595 | ||||||||
| Practice Location | |||||||||
| Address1: | 22922 N 40TH PL | ||||||||
| Address2: | |||||||||
| City: | PHOENIX | ||||||||
| State: | AZ | ||||||||
| PostalCode: | 850508742 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2362951190 | ||||||||
| FaxNumber: | 6024298595 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 10/26/2017 | ||||||||
| LastUpdateDate: | 12/29/2021 | ||||||||
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| AuthorizedOfficialLastName: | NASSER | ||||||||
| AuthorizedOfficialFirstName: | MOHAMMAD | ||||||||
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| AuthorizedOfficialTitleorPosition: | CEO/MD | ||||||||
| AuthorizedOfficialTelephone: | 6232951190 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | DR. | ||||||||
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| AuthorizedOfficialCredential: | MD | ||||||||
| NPICertificationDate: | 12/29/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 163WE0003X | N | 193200000X MULTI-SPECIALTY GROUP | Nursing Service Providers | Registered Nurse | Emergency | 207Q00000X | N | 193200000X MULTI-SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Family Medicine | 208M00000X | 47483 | AZ | N | 193200000X MULTI-SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Hospitalist | 363AM0700X | N | 193200000X MULTI-SPECIALTY GROUP | Physician Assistants & Advanced Practice Nursing Providers | Physician Assistant | Medical | 363LA2100X | N | 193200000X MULTI-SPECIALTY GROUP | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Acute Care | 208M00000X | Y | 193200000X MULTI-SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Hospitalist |
ID Information
| ID | Type | State | Issuer | Description | 354728 | 05 | AZ | MEDICAID |