Basic Information
| Provider Information | |||||||||
| NPI: | 1902324551 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | LEADING EDGE EMERGENCY PHYSICIANS, INC | ||||||||
| LastName: | |||||||||
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| OtherOrganizationName: | LEEP EL PASO | ||||||||
| OtherOrganizationType: | 3 | ||||||||
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| Mailing Information | |||||||||
| Address1: | 8686 NEW TRAILS DR SUITE 100 | ||||||||
| Address2: | |||||||||
| City: | THE WOODLANDS | ||||||||
| State: | TX | ||||||||
| PostalCode: | 773811176 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7136371146 | ||||||||
| FaxNumber: | 2812985311 | ||||||||
| Practice Location | |||||||||
| Address1: | 13600 HORIZON BLVD SUITE 100 | ||||||||
| Address2: | |||||||||
| City: | HORIZON CITY | ||||||||
| State: | TX | ||||||||
| PostalCode: | 79928 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9154077878 | ||||||||
| FaxNumber: | 9158521804 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 09/05/2017 | ||||||||
| LastUpdateDate: | 09/05/2017 | ||||||||
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| AuthorizedOfficialLastName: | MIDDLEBROOK | ||||||||
| AuthorizedOfficialFirstName: | JOHN | ||||||||
| AuthorizedOfficialMiddleName: | D | ||||||||
| AuthorizedOfficialTitleorPosition: | CHIEF MEDICAL OFFICER | ||||||||
| AuthorizedOfficialTelephone: | 7136371003 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | Y | ||||||||
| ParentOrganizationLBN: | LEADING EDGE EMERGENCY PHYSICIANS, INC | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207P00000X | Y | 193200000X MULTI-SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Emergency Medicine |
No ID Information.