Provider Demographics
NPI:1649209289
Name:HUGH M LEAVENS M.D.
Entity Type:Organization
Organization Name:HUGH M LEAVENS M.D.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:HUGH
Authorized Official - Middle Name:M
Authorized Official - Last Name:LEAVENS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:803-649-9200
Mailing Address - Street 1:103 WATERLOO ST SW
Mailing Address - Street 2:
Mailing Address - City:AIKEN
Mailing Address - State:SC
Mailing Address - Zip Code:29801-3756
Mailing Address - Country:US
Mailing Address - Phone:803-649-9200
Mailing Address - Fax:803-649-9005
Practice Address - Street 1:103 WATERLOO ST SW
Practice Address - Street 2:
Practice Address - City:AIKEN
Practice Address - State:SC
Practice Address - Zip Code:29801-3756
Practice Address - Country:US
Practice Address - Phone:803-649-9200
Practice Address - Fax:803-649-9005
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-03
Last Update Date:2010-09-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC17742207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCGP1104Medicaid
SCGP1104Medicaid
SCE79836Medicare UPIN