Provider Demographics
NPI:1740647866
Name:MEDLEADERS LLC
Entity type:Organization
Organization Name:MEDLEADERS LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OPERATIONS MANAGER
Authorized Official - Prefix:MS
Authorized Official - First Name:COURTNEY
Authorized Official - Middle Name:LEIGH
Authorized Official - Last Name:ALTAZIN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:225-243-6997
Mailing Address - Street 1:PO BOX 78070
Mailing Address - Street 2:
Mailing Address - City:BATON ROUGE
Mailing Address - State:LA
Mailing Address - Zip Code:70837-8070
Mailing Address - Country:US
Mailing Address - Phone:225-243-6997
Mailing Address - Fax:225-243-7157
Practice Address - Street 1:8369 FLORIDA BLVD
Practice Address - Street 2:SUITE 9
Practice Address - City:DENHAM SPRINGS
Practice Address - State:LA
Practice Address - Zip Code:70726-7862
Practice Address - Country:US
Practice Address - Phone:225-243-6997
Practice Address - Fax:225-243-7157
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-01-20
Last Update Date:2016-01-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA025596207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA025596OtherLICENSE NUMBER
LA4F305B116Medicare PIN
LAH84100Medicare UPIN