Basic Information
| Provider Information | |||||||||
| NPI: | 1629126115 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | LEITNER UROLOGY, PA | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1428A ELLEN ST | ||||||||
| Address2: | |||||||||
| City: | MONROE | ||||||||
| State: | NC | ||||||||
| PostalCode: | 281125173 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7042894361 | ||||||||
| FaxNumber: | 7042834705 | ||||||||
| Practice Location | |||||||||
| Address1: | 1428A ELLEN ST | ||||||||
| Address2: | |||||||||
| City: | MONROE | ||||||||
| State: | NC | ||||||||
| PostalCode: | 281125173 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7042894361 | ||||||||
| FaxNumber: | 7042834705 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 01/08/2007 | ||||||||
| LastUpdateDate: | 07/26/2007 | ||||||||
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| AuthorizedOfficialLastName: | VANCE | ||||||||
| AuthorizedOfficialFirstName: | NICOLE | ||||||||
| AuthorizedOfficialMiddleName: | M. | ||||||||
| AuthorizedOfficialTitleorPosition: | NURSE, OFFICE MANAGER | ||||||||
| AuthorizedOfficialTelephone: | 7042894361 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | MISS | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 174400000X | 30830 | NC | Y | 193400000X SINGLE SPECIALTY GROUP | Other Service Providers | Specialist |
No ID Information.