LESLIE PAUL EDGCOMB (NPI# 1629014022) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1629014022 |
| Entity Type | Individual |
| Full Name | LESLIE PAUL EDGCOMB |
| Credential | M.D. |
| Practice Address |
5668 E State St Rockford IL 61108-2464 |
| Practice Telephone | 8152297580 |
| Mailing Telephone | 8152297580 |
| Enumeration Date | 2006-06-22 |
| Last Update Date | 2015-10-06 |
| Gender Code | M |
| Is Sole Proprietor | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 2086S0129X |
Surgery Specialization: Vascular Surgery |
036072104 | IL | Allopathic & Osteopathic Physicians |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| WI | 30696600 | 05 | |
| IL | 036072104 | 05 | |
| RAILROAD MEDICARE | 020017328 | 01 |
| Street Address |
5668 E STATE ST |
| City | ROCKFORD |
| State | IL |
| Zip Code | 61108-2464 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1477553659 | Mark E Hastings | Orthopaedic Surgery | 5668 E State St, Suite 400, Rockford, IL 61108-2490 | 2005-07-28 |
| 1013453075 | Melissa L. Inman | Nurse Practitioner | 5668 E State St, Rockford, IL 61108-2464 | 2017-01-16 |
| 1326408436 | Victoria Mccoy | Nurse Practitioner | 5668 E State St, Rockford, IL 61108-2464 | 2016-03-02 |
| 1477975175 | Lonn E Brander Dds Ltd | Durable Medical Equipment & Medical Supplies | 5668 E State St, Suite 1100, Rockford, IL 61108-2490 | 2014-01-15 |
| 1447550884 | Tetsuya Takeuchi | Surgery | 5668 E State St, Rockford, IL 61108-2464 | 2010-11-02 |
| 1558686709 | Michael Anthony Hart | Surgery | 5668 E State St, Rockford, IL 61108-2464 | 2010-03-31 |
| 1285965905 | John Eric Player | Surgery | 5668 E State St, Suite 1000, Rockford, IL 61108-2464 | 2010-01-20 |
| 1568795441 | Denise M Nordenberg | Nurse Practitioner | 5668 E State St, Rockford, IL 61108-2464 | 2009-09-10 |
| 1063686848 | Dacia Aurelia Pickering | Surgery | 5668 E State St, #2, Rockford, IL 61108-2490 | 2008-04-14 |
| 1942485735 | Sameer Ansar | Internal Medicine | 5668 E State St, Suite 2000, Rockford, IL 61108-2490 | 2007-12-31 |
| Find all providers in the same location | ||||
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1952862617 | Isr Enterprises, Inc. | Homemaker | 129 Phelps Ave, Bldg 10, Ste 1008, Rockford, IL 61108 | 2019-03-26 |
| 1003306465 | Adrienne Nicole Black | Behavior Technician | 519 Woodland Dr, Woodland Dr, Rockford, IL 61108 | 2018-05-11 |
| 1184085201 | Integrative Healing Center, LLC | Clinic/Center | 6019 Fincham Drive, Rockford, IL 61108 | 2016-03-17 |
| 1730547936 | Perryville Dentist PC | Dentist | 845 S Perryville Rd, Unit 119, Rockford, IL 61108 | 2016-02-02 |
| 1023489853 | Nicole Ping Ticknor | Counselor | 433 S. Phelps Ave., Suite 2, Rockford, IL 61108 | 2015-10-20 |
| 1275940348 | Northwest Home Care, Inc. | Home Health | 1437 S. Bell School Road, Suite 7, Rockford, IL 61108 | 2014-07-21 |
| 1487072922 | Alecia Greenlee | Psychiatry & Neurology | Rosecrance Community Mental Health, 3815 Harrison Avenue, Rockford, IL 61108 | 2014-04-02 |
| 1871925446 | Maria Laura Gustafson | Interpreter | 3208 Wesleyan Ave., Rockford, IL 61108 | 2013-08-06 |
| 1346582822 | Joseph Peevey | Pathology | 5666 E State Street, Department of Pathology, Rockford, IL 61108 | 2013-03-21 |
| 1134466923 | James Henry Peck | Hearing Instrument Specialist | 2424 Charles St, Rockford, IL 61108 | 2013-01-14 |
| Find all providers in zip 61108 | ||||
| Taxonomy Code | 2086S0129X |
| Grouping | Allopathic & Osteopathic Physicians |
| Classification | Surgery |
| Specialization | Vascular Surgery |
| A surgeon with expertise in the management of surgical disorders of the blood vessels, excluding the intracranial vessels or the heart. |
| Notes: Source: American Board of Medical Specialties, 2007. www.abms.org [7/1/2007: definition added, source added; 7/1/2011: modified source] - Additional Resources: American Board of Surgery, 2007. http://www.absurgery.org/. American Osteopathic Board of Surgery, 2007. http://www.osteopathic.org/certification - Board certification for Medical Doctors (MDs) is provided by the American Board of Surgery. Board certification for Doctors of Osteopathy (DOs) is provided by the American Osteopathic Board of Surgery. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1851394696 | Affiliated Surgeons of Rockford LLC | Surgery | 2300 N Rockton Ave, Ste 304, Rockford, IL 61103-3619 | 2005-05-24 |
| 1346468105 | Heather Anne Hall | Surgery | 2350 N Rockton Ave, Rockford, IL 61103-3600 | 2007-04-24 |
| 1548386998 | Swedishamerican Hospital | Surgery | 2300 N Rockton Ave, Rockford, IL 61103-3619 | 2007-03-21 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1396267324 | Congress Vascular Center LLC | Surgery | 41 W Congress Pkwy Fl 1, Chicago, IL 60605-1531 | 2017-07-11 |
| 1043731300 | Elmwood Park Vascular Center LLC | Surgery | 7230 W North Ave Ste 108, Elmwood Park, IL 60707-4261 | 2017-06-27 |
| 1588105811 | Mickey Graphia | Surgery | 701 N 1st St # D346, Springfield, IL 62702 | 2017-03-20 |
| 1992126668 | Vascular Specialists LLC | Surgery | 20060 Governors Dr Ste 102, Olympia Fields, IL 60461-1099 | 2013-12-26 |
| 1588959548 | Patrick Michael Sullivan Neville | Surgery | 4600 Memorial Dr Ste 120, Belleville, IL 62226-5359 | 2011-06-17 |
| 1235454968 | Margaret Claire Rigamer | Surgery | 1901 W Harrison St Dept Of, Chicago, IL 60612-3714 | 2010-04-06 |
| 1215251541 | John V. White, Md, LLC | Surgery | 8816 W Dempster St, Niles, IL 60714-5109 | 2010-03-15 |
| 1710212733 | Vascular Surgery and Interpretation S.c. | Surgery | 3330 W 177th St Ste 2c1, Hazel Crest, IL 60429-2184 | 2009-10-08 |
| 1538391792 | Usa Vein Clinics of Chicago LLC | Surgery | 4141 Dundee Rd, Northbrook, IL 60062-2129 | 2009-08-20 |
| 1306010731 | Tanq, Inc. | Surgery | 18510 S Marilynn Ct, Mokena, IL 60448-9517 | 2008-04-16 |
| Find all providers with the same taxonomy | ||||
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.