Provider Demographics
NPI:1316108996
Name:SCOTT M. LEEDS, MD, A MEDICAL CORPORATION
Entity type:Organization
Organization Name:SCOTT M. LEEDS, MD, A MEDICAL CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BILLER
Authorized Official - Prefix:
Authorized Official - First Name:ARIEL
Authorized Official - Middle Name:Z
Authorized Official - Last Name:WEEKS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:310-740-2601
Mailing Address - Street 1:PO BOX 5801
Mailing Address - Street 2:
Mailing Address - City:BEVERLY HILLS
Mailing Address - State:CA
Mailing Address - Zip Code:90209-5801
Mailing Address - Country:US
Mailing Address - Phone:310-777-0159
Mailing Address - Fax:310-777-0160
Practice Address - Street 1:415 N CRESCENT DR STE 225
Practice Address - Street 2:
Practice Address - City:BEVERLY HILLS
Practice Address - State:CA
Practice Address - Zip Code:90210-6809
Practice Address - Country:US
Practice Address - Phone:310-777-0159
Practice Address - Fax:310-777-0160
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-06-17
Last Update Date:2009-12-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA79005174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAA79005Medicare UPIN
BQ989ZMedicare PIN
CABQ990Medicare PIN
CAA79005Medicare PIN