1356342711 NPI number — MRS. STACEY WEICHERS LANG DC

Table of content: MRS. STACEY WEICHERS LANG DC (NPI 1356342711)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1356342711 NPI number — MRS. STACEY WEICHERS LANG DC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
LANG
Provider First Name:
STACEY
Provider Middle Name:
WEICHERS
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
DC
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
DANGREMOND
Provider Other First Name:
STACEYK
Provider Other Middle Name:
WICHERS
Provider Other Name Prefix Text:
MISS
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1356342711
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/08/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
8459 US HIGHWAY 42
Provider Second Line Business Mailing Address:
SUITE E
Provider Business Mailing Address City Name:
FLORENCE
Provider Business Mailing Address State Name:
KY
Provider Business Mailing Address Postal Code:
41042-8350
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
859-283-5070
Provider Business Mailing Address Fax Number:
859-283-5071

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
8459 US HIGHWAY 42
Provider Second Line Business Practice Location Address:
SUITE E
Provider Business Practice Location Address City Name:
FLORENCE
Provider Business Practice Location Address State Name:
KY
Provider Business Practice Location Address Postal Code:
41042-8350
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
859-283-5070
Provider Business Practice Location Address Fax Number:
859-283-5071
Provider Enumeration Date:
08/09/2005

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 111N00000X , with the licence number:  4669 , registered in the state of KY ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 000000214501 . This is a "ANTHEM" identifier , issued by the state of ( KY ) . This identifiers is of the category "OTHER".
  • Identifier: 7795285 . This is a "AETNA" identifier , issued by the state of ( KY ) . This identifiers is of the category "OTHER".
  • Identifier: 85002145 , issued by the state of ( KY ) . This identifiers is of the category "MEDICAID".
  • Identifier: 1193041 . This is a "CHA" identifier , issued by the state of ( KY ) . This identifiers is of the category "OTHER".
  • Identifier: KY669C . This is a "HUMANA" identifier , issued by the state of ( KY ) . This identifiers is of the category "OTHER".




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