Provider Demographics
NPI:1710954383
Name:SCOTT G. LEEKA DBA ALTERNATIVE MEDICAL SOLUTIONS
Entity Type:Organization
Organization Name:SCOTT G. LEEKA DBA ALTERNATIVE MEDICAL SOLUTIONS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRERSIDENT
Authorized Official - Prefix:
Authorized Official - First Name:SCOTT
Authorized Official - Middle Name:GLYNN
Authorized Official - Last Name:LEEKA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:662-895-1543
Mailing Address - Street 1:7139 COMMERCE DRIVE, BLDG. C3
Mailing Address - Street 2:
Mailing Address - City:OLIVE BRANCH
Mailing Address - State:MS
Mailing Address - Zip Code:38654
Mailing Address - Country:US
Mailing Address - Phone:662-895-1543
Mailing Address - Fax:662-893-5990
Practice Address - Street 1:7139 COMMERCE DR., BLDG. C-3
Practice Address - Street 2:
Practice Address - City:OLIVE BRANCH
Practice Address - State:MS
Practice Address - Zip Code:38654
Practice Address - Country:US
Practice Address - Phone:662-895-1543
Practice Address - Fax:662-893-5990
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-03-02
Last Update Date:2008-07-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR006675332B00000X
TN0871332B00000X
MS0381411.1332B00000X
MS03814/ 11.1332B00000X
AR018222332B00000X
TN871332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR128837716OtherNOT STATED
LA1750930Medicaid
MS0381411.1Medicaid
MS00440335Medicaid
TN4581825OtherNOT STATED
AR128837716Medicaid
TN4581825Medicaid
AR128837716Medicaid
LA1750930Medicaid