Provider Demographics
NPI:1790901569
Name:LEEDHANACHOKE & CASSADY, P.S.C.
Entity Type:Organization
Organization Name:LEEDHANACHOKE & CASSADY, P.S.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:OON
Authorized Official - Middle Name:
Authorized Official - Last Name:LEEDHANACHOKE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:606-437-6698
Mailing Address - Street 1:PO BOX 3369
Mailing Address - Street 2:
Mailing Address - City:PIKEVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:41502-3369
Mailing Address - Country:US
Mailing Address - Phone:606-437-6698
Mailing Address - Fax:606-432-5502
Practice Address - Street 1:387 TOWN MOUNTAIN RD STE 207
Practice Address - Street 2:
Practice Address - City:PIKEVILLE
Practice Address - State:KY
Practice Address - Zip Code:41501-1642
Practice Address - Country:US
Practice Address - Phone:606-437-6698
Practice Address - Fax:606-432-5502
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-18
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY20275208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208600000XAllopathic & Osteopathic PhysiciansSurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY64274814Medicaid
KY1013501Medicare ID - Type Unspecified