Provider Demographics
NPI:1609086834
Name:LESLIE ORTHOPEDICS AND SPORTS MEDICINE INC
Entity Type:Organization
Organization Name:LESLIE ORTHOPEDICS AND SPORTS MEDICINE INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MISS
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:JOE
Authorized Official - Last Name:BRUCE
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:573-346-3700
Mailing Address - Street 1:226 E US HIGHWAY 54
Mailing Address - Street 2:
Mailing Address - City:CAMDENTON
Mailing Address - State:MO
Mailing Address - Zip Code:65020-6819
Mailing Address - Country:US
Mailing Address - Phone:573-346-3700
Mailing Address - Fax:573-346-3307
Practice Address - Street 1:226 E US HIGHWAY 54
Practice Address - Street 2:
Practice Address - City:CAMDENTON
Practice Address - State:MO
Practice Address - Zip Code:65020-6819
Practice Address - Country:US
Practice Address - Phone:573-346-3700
Practice Address - Fax:573-346-3307
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-23
Last Update Date:2008-02-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MORP344207XP3100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207XP3100XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryPediatric Orthopaedic SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO1922012772OtherCHRIS LESLIE, D.O.
MO1023031762OtherBRIAN D. SWANSON
MOE81798Medicare UPIN
MOP00282602Medicare PIN
MOQ40418Medicare UPIN
MO1298500001Medicare NSC