Provider Demographics
NPI:1952320822
Name:LEACHMAN CARDIOLOGY ASSOCIATES PA
Entity Type:Organization
Organization Name:LEACHMAN CARDIOLOGY ASSOCIATES PA
Other - Org Name:LEACHMAN CARDIOLOGY ASSOCIATES LLP
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:DEWITT
Authorized Official - Middle Name:RICHARD
Authorized Official - Last Name:LEACHMAN
Authorized Official - Suffix:
Authorized Official - Credentials:MD, FACC
Authorized Official - Phone:713-790-9401
Mailing Address - Street 1:6624 FANNIN ST
Mailing Address - Street 2:SUITE 2780
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77030-2312
Mailing Address - Country:US
Mailing Address - Phone:713-790-9401
Mailing Address - Fax:713-790-0353
Practice Address - Street 1:6624 FANNIN ST
Practice Address - Street 2:SUITE 2780
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77030-2312
Practice Address - Country:US
Practice Address - Phone:713-790-9401
Practice Address - Fax:713-790-0353
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-19
Last Update Date:2010-01-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX0094EBOtherBLUE CROSS/BLUE SHIELD TX
TX1093932 02Medicaid
TX0094EBOtherBLUE CROSS/BLUE SHIELD TX