Provider Demographics
NPI:1245568765
Name:LEONIDES V SANTOS PC
Entity Type:Organization
Organization Name:LEONIDES V SANTOS PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:LEONIDES
Authorized Official - Middle Name:V
Authorized Official - Last Name:SANTOS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:256-332-3321
Mailing Address - Street 1:201 JACKSON AVE S
Mailing Address - Street 2:
Mailing Address - City:RUSSELLVILLE
Mailing Address - State:AL
Mailing Address - Zip Code:35653-2233
Mailing Address - Country:US
Mailing Address - Phone:256-332-3321
Mailing Address - Fax:256-331-0720
Practice Address - Street 1:201 JACKSON AVE S
Practice Address - Street 2:
Practice Address - City:RUSSELLVILLE
Practice Address - State:AL
Practice Address - Zip Code:35653-2233
Practice Address - Country:US
Practice Address - Phone:256-332-3321
Practice Address - Fax:256-331-0720
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-11-20
Last Update Date:2010-06-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ALASCS8441208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208600000XAllopathic & Osteopathic PhysiciansSurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL000010297Medicaid
AL000010297Medicaid
ALC70991Medicare UPIN