Provider Demographics
NPI:1437180726
Name:LEIGHTON ORTHOPAEDICS AND SPORTS MEDICINE P.C.
Entity Type:Organization
Organization Name:LEIGHTON ORTHOPAEDICS AND SPORTS MEDICINE P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/DOCTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:RICHARD
Authorized Official - Middle Name:MATTHEW
Authorized Official - Last Name:LEIGHTON
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:910-575-5800
Mailing Address - Street 1:20 MEDICAL CAMPUS DR
Mailing Address - Street 2:SUTIE 104
Mailing Address - City:SUPPLY
Mailing Address - State:NC
Mailing Address - Zip Code:28462-4096
Mailing Address - Country:US
Mailing Address - Phone:910-575-5800
Mailing Address - Fax:910-579-1174
Practice Address - Street 1:20 MEDICAL CAMPUS DR
Practice Address - Street 2:SUITE 104
Practice Address - City:SUPPLY
Practice Address - State:NC
Practice Address - Zip Code:28462-4096
Practice Address - Country:US
Practice Address - Phone:910-575-5800
Practice Address - Fax:910-579-1174
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-05
Last Update Date:2016-09-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207XX0005XAllopathic & Osteopathic PhysiciansOrthopaedic SurgerySports MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC89-51630Medicaid
NC89-51630Medicaid
7517160001Medicare NSC
NC2340654Medicare ID - Type Unspecified