Provider Demographics
NPI:1245652478
Name:LEONARD BERRY JR. LLC
Entity type:Organization
Organization Name:LEONARD BERRY JR. LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MISS
Authorized Official - First Name:YVETTE
Authorized Official - Middle Name:R
Authorized Official - Last Name:WEBBER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:972-225-0081
Mailing Address - Street 1:PO BOX 860
Mailing Address - Street 2:HUTCHINS, TX
Mailing Address - City:HUTCHINS
Mailing Address - State:TX
Mailing Address - Zip Code:75141-0860
Mailing Address - Country:US
Mailing Address - Phone:972-225-0081
Mailing Address - Fax:972-225-0805
Practice Address - Street 1:9455 S LANCASTER HUTCHINS RD
Practice Address - Street 2:
Practice Address - City:HUTCHINS
Practice Address - State:TX
Practice Address - Zip Code:75141-3368
Practice Address - Country:US
Practice Address - Phone:972-225-0081
Practice Address - Fax:972-225-0805
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-01-07
Last Update Date:2014-01-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXH3620282N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes282N00000XHospitalsGeneral Acute Care Hospital
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX8BN470OtherBCBS
TX1393175 17Medicaid
TX8BN470OtherBCBS
TXE50982Medicare UPIN