Provider Demographics
NPI:1710048574
Name:LEADING EDGE SERVICES INTERNATIONAL, INC.
Entity Type:Organization
Organization Name:LEADING EDGE SERVICES INTERNATIONAL, INC.
Other - Org Name:FAMILY HEALTH CENTER-LOUISIANA
Other - Org Type:Doing Business As
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:ANTHONIA
Authorized Official - Middle Name:
Authorized Official - Last Name:IMUDIA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:504-468-6645
Mailing Address - Street 1:3715 WILLIAMS BLVD
Mailing Address - Street 2:SUITE100
Mailing Address - City:KENNER
Mailing Address - State:LA
Mailing Address - Zip Code:70065-3075
Mailing Address - Country:US
Mailing Address - Phone:504-468-6645
Mailing Address - Fax:504-468-6646
Practice Address - Street 1:3715 WILLIAMS BLVD
Practice Address - Street 2:SUITE100
Practice Address - City:KENNER
Practice Address - State:LA
Practice Address - Zip Code:70065-3075
Practice Address - Country:US
Practice Address - Phone:504-468-6645
Practice Address - Fax:504-468-6646
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-13
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA4128261QP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care