Provider Demographics
NPI:1104136241
Name:LEADING EDGE SERVICES INTERNATIONAL, INC
Entity type:Organization
Organization Name:LEADING EDGE SERVICES INTERNATIONAL, INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:ANTHONIA
Authorized Official - Middle Name:
Authorized Official - Last Name:IMUDIA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:504-361-3777
Mailing Address - Street 1:PO BOX 641324
Mailing Address - Street 2:
Mailing Address - City:KENNER
Mailing Address - State:LA
Mailing Address - Zip Code:70064-1324
Mailing Address - Country:US
Mailing Address - Phone:504-361-3777
Mailing Address - Fax:504-910-3029
Practice Address - Street 1:1501 NEWTON ST
Practice Address - Street 2:SUITE C
Practice Address - City:NEW ORLEANS
Practice Address - State:LA
Practice Address - Zip Code:70114-2562
Practice Address - Country:US
Practice Address - Phone:504-361-3777
Practice Address - Fax:504-910-3029
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-10-07
Last Update Date:2010-10-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care