Basic Information
| Provider Information | |||||||||
| NPI: | 1457921413 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | LEADING HEALTH MANAGED CARE | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 163 | ||||||||
| Address2: | |||||||||
| City: | TEMPE | ||||||||
| State: | AZ | ||||||||
| PostalCode: | 852800163 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6232951190 | ||||||||
| FaxNumber: | 6024298595 | ||||||||
| Practice Location | |||||||||
| Address1: | 22922 N 40TH PL | ||||||||
| Address2: | |||||||||
| City: | PHOENIX | ||||||||
| State: | AZ | ||||||||
| PostalCode: | 850508742 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6232951190 | ||||||||
| FaxNumber: | 6024298595 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/30/2021 | ||||||||
| LastUpdateDate: | 08/16/2021 | ||||||||
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| AuthorizedOfficialLastName: | NASSER | ||||||||
| AuthorizedOfficialFirstName: | MOHAMMAH | ||||||||
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| AuthorizedOfficialTitleorPosition: | OWNER | ||||||||
| AuthorizedOfficialTelephone: | 3134855680 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialCredential: | MD | ||||||||
| NPICertificationDate: | 08/16/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207R00000X | N | 193200000X MULTI-SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Internal Medicine | 261QM1300X | N | Ambulatory Health Care Facilities | Clinic/Center | Multi-Specialty | 174400000X | Y | 193200000X MULTI-SPECIALTY GROUP | Other Service Providers | Specialist |
No ID Information.