Provider Demographics
NPI:1740305838
Name:LESLIE MOBILITY INC
Entity type:Organization
Organization Name:LESLIE MOBILITY INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRES
Authorized Official - Prefix:
Authorized Official - First Name:MILLARD
Authorized Official - Middle Name:F
Authorized Official - Last Name:LESLIE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:989-652-6693
Mailing Address - Street 1:126 S MAIN ST
Mailing Address - Street 2:
Mailing Address - City:FRANKENMUTH
Mailing Address - State:MI
Mailing Address - Zip Code:48734-1612
Mailing Address - Country:US
Mailing Address - Phone:989-652-6693
Mailing Address - Fax:989-652-6587
Practice Address - Street 1:126 S MAIN ST
Practice Address - Street 2:
Practice Address - City:FRANKENMUTH
Practice Address - State:MI
Practice Address - Zip Code:48734-1612
Practice Address - Country:US
Practice Address - Phone:989-652-6693
Practice Address - Fax:989-652-6587
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-20
Last Update Date:2008-08-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI540G30287OtherBLUE CROSS BLUE SHIELD MI
MI0267230001OtherDMERC REGION B
MI3135711Medicaid
MI0267230001OtherDMERC REGION B
MI0267230001Medicare ID - Type Unspecified