Provider Demographics
NPI:1871716746
Name:EDWARD W LEAHEY MD PROFESSIONAL ASSOCIATION
Entity type:Organization
Organization Name:EDWARD W LEAHEY MD PROFESSIONAL ASSOCIATION
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OFFICE ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:SANDRA
Authorized Official - Middle Name:ABBY
Authorized Official - Last Name:LEAHEY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:832-385-1631
Mailing Address - Street 1:4201 GARTH RD STE 100
Mailing Address - Street 2:
Mailing Address - City:BAYTOWN
Mailing Address - State:TX
Mailing Address - Zip Code:77521-3154
Mailing Address - Country:US
Mailing Address - Phone:281-422-3113
Mailing Address - Fax:281-427-6289
Practice Address - Street 1:4201 GARTH RD STE 100
Practice Address - Street 2:
Practice Address - City:BAYTOWN
Practice Address - State:TX
Practice Address - Zip Code:77521-3154
Practice Address - Country:US
Practice Address - Phone:281-422-3113
Practice Address - Fax:281-427-6289
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-10
Last Update Date:2021-09-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXE9763174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX180530102Medicaid
TXDF1985OtherMEDICARE RR
TX0095PVOtherBC/BS
TX009337OtherMEDICARE GROUP
TX009337Medicare PIN
TXC18228Medicare UPIN