1629314687 NPI number — ERICH E. MENGE, DC,PA

Table of content: (NPI 1629314687)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1629314687 NPI number — ERICH E. MENGE, DC,PA

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
ERICH E. MENGE, DC,PA
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1629314687
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
12/19/2012
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
4801 LINTON BLVD STE 9A
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
DELRAY BEACH
Provider Business Mailing Address State Name:
FL
Provider Business Mailing Address Postal Code:
33445-6501
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
561-495-4357
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
4801 LINTON BLVD STE 9A
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
DELRAY BEACH
Provider Business Practice Location Address State Name:
FL
Provider Business Practice Location Address Postal Code:
33445-6501
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
561-495-4357
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
12/19/2012

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
MENGE
Authorized Official First Name:
ERICH
Authorized Official Middle Name:
E
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
561-495-4357

Provider Taxonomy Codes

  • Taxonomy code: 111N00000X , with the licence number:  CH9560 , registered in the state of FL ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 7209250 . This is a "AETNA" identifier . This identifiers is of the category "OTHER".
  • Identifier: 88701 . This is a "BLUE CROSS BLUE SHIELD" identifier . This identifiers is of the category "OTHER".
  • Identifier: 2138246 . This is a "UNITED" identifier . This identifiers is of the category "OTHER".
  • Identifier: 1414695 . This is a "CIGNA" identifier . This identifiers is of the category "OTHER".