Basic Information
| Provider Information | |||||||||
| NPI: | 1295731016 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | LEDLEY | ||||||||
| FirstName: | ANNMARIE | ||||||||
| MiddleName: | MCRENA | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | D.O. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 4311 WESLEY ST | ||||||||
| Address2: | |||||||||
| City: | GREENVILLE | ||||||||
| State: | TX | ||||||||
| PostalCode: | 754015639 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9034555986 | ||||||||
| FaxNumber: | 9034544621 | ||||||||
| Practice Location | |||||||||
| Address1: | 4500 WESLEY ST | ||||||||
| Address2: | |||||||||
| City: | GREENVILLE | ||||||||
| State: | TX | ||||||||
| PostalCode: | 754015644 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9034555986 | ||||||||
| FaxNumber: | 9034544621 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/27/2005 | ||||||||
| LastUpdateDate: | 04/10/2012 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 174400000X | K6640 | TX | Y | Other Service Providers | Specialist | 207V00000X | OS013698 | PA | N | Allopathic & Osteopathic Physicians | Obstetrics & Gynecology | 207VF0040X | K6640 | TX | N | Allopathic & Osteopathic Physicians | Obstetrics & Gynecology | Female Pelvic Medicine and Reconstructive Surgery |
ID Information
| ID | Type | State | Issuer | Description | 1018018780001 | 05 | PA | MEDICAID | K6640 | 01 | TX | STATE LICENSE NUMBER | OTHER | OS013698 | 01 | PA | MEDICAL LICENSE NUMBER | OTHER | 092276701 | 05 | TX | MEDICAID |