Provider Demographics
NPI:1295212173
Name:LEECH&QUALITY TRANSPORTAION LLC
Entity Type:Organization
Organization Name:LEECH&QUALITY TRANSPORTAION LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:RAYMOND
Authorized Official - Middle Name:
Authorized Official - Last Name:LEECH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:662-574-1265
Mailing Address - Street 1:618 22ND ST S
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:MS
Mailing Address - Zip Code:39701-6606
Mailing Address - Country:US
Mailing Address - Phone:662-574-1265
Mailing Address - Fax:662-630-5077
Practice Address - Street 1:618 22ND ST S
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:MS
Practice Address - Zip Code:39701-6606
Practice Address - Country:US
Practice Address - Phone:662-574-1265
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-07-24
Last Update Date:2018-07-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS=========Medicaid