Provider Demographics
NPI:1538217179
Name:LEBAUER MEDICAL CENTER, PLLC
Entity type:Organization
Organization Name:LEBAUER MEDICAL CENTER, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:PATRICK
Authorized Official - Middle Name:W
Authorized Official - Last Name:BILLINGS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:336-282-2300
Mailing Address - Street 1:3201 BRASSFIELD RD
Mailing Address - Street 2:SUITE 400
Mailing Address - City:GREENSBORO
Mailing Address - State:NC
Mailing Address - Zip Code:27410-9682
Mailing Address - Country:US
Mailing Address - Phone:336-282-2300
Mailing Address - Fax:336-282-0034
Practice Address - Street 1:3201 BRASSFIELD RD
Practice Address - Street 2:SUITE 400
Practice Address - City:GREENSBORO
Practice Address - State:NC
Practice Address - Zip Code:27410-9682
Practice Address - Country:US
Practice Address - Phone:336-282-2300
Practice Address - Fax:336-282-0034
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-08
Last Update Date:2025-06-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207KA0200XAllopathic & Osteopathic PhysiciansAllergy & ImmunologyAllergyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
=========OtherTAX ID
=========OtherTAX ID
NC2326481AMedicare PIN