Basic Information
Provider Information | |||||||||
NPI: | 1679556922 | ||||||||
EntityType: | 1 | ||||||||
ReplacementNPI: |   | ||||||||
OrganizationName: |   | ||||||||
LastName: | LEDGER | ||||||||
FirstName: | HAROLD | ||||||||
MiddleName: | ASHLEY | ||||||||
NamePrefix: |   | ||||||||
NameSuffix: |   | ||||||||
Credential: | DPM | ||||||||
OtherOrganizationName: |   | ||||||||
OtherOrganizationType: |   | ||||||||
OtherLastName: |   | ||||||||
OtherFirstName: |   | ||||||||
OtherMiddleName: |   | ||||||||
OtherNamePrefix: |   | ||||||||
OtherNameSuffix: |   | ||||||||
OtherCredential: |   | ||||||||
OtherLastNameType: |   | ||||||||
Mailing Information | |||||||||
Address1: | PO BOX 11538 | ||||||||
Address2: |   | ||||||||
City: | KILLEEN | ||||||||
State: | TX | ||||||||
PostalCode: | 765471538 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 2542459177 | ||||||||
FaxNumber: | 2542459178 | ||||||||
Practice Location | |||||||||
Address1: | 800 W CENTRAL TEXAS EXPY | ||||||||
Address2: | SUITE 155 | ||||||||
City: | HARKER HEIGHTS | ||||||||
State: | TX | ||||||||
PostalCode: | 765481899 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 2545193668 | ||||||||
FaxNumber: | 2545013668 | ||||||||
Other Information | |||||||||
ProviderEnumerationDate: | 11/21/2005 | ||||||||
LastUpdateDate: | 09/28/2017 | ||||||||
NPIDeactivationReasonCode: |   | ||||||||
NPIDeactivationDate: |   | ||||||||
NPIReactivationDate: |   | ||||||||
ProviderGenderCode: | M | ||||||||
AuthorizedOfficialLastName: |   | ||||||||
AuthorizedOfficialFirstName: |   | ||||||||
AuthorizedOfficialMiddleName: |   | ||||||||
AuthorizedOfficialTitleorPosition: |   | ||||||||
AuthorizedOfficialTelephone: |   | ||||||||
IsSoleProprietor: | N | ||||||||
IsOrganizationSubpart: |   | ||||||||
ParentOrganizationLBN: |   | ||||||||
AuthorizedOfficialNamePrefix: |   | ||||||||
AuthorizedOfficialNameSuffix: |   | ||||||||
AuthorizedOfficialCredential: |   | ||||||||
NPICertificationDate: |   |
Taxonomy Information
Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 213E00000X | 1582 | TX | Y |   | Podiatric Medicine & Surgery Service Providers | Podiatrist |   |
ID Information
ID | Type | State | Issuer | Description | 166304901 | 05 | TX |   | MEDICAID | 200864279 | 01 | TX | HUMANA/MILITARY-TRICARE | OTHER | P00142246 | 01 | TX | MEDICARE RAILROAD | OTHER | 8M5670 | 01 | TX | BLUE CROSS BLUE SHIELD | OTHER |