1821410630 NPI number — MR. MICHAEL ANTHONY LANGSTON SR.

Table of content: MR. MICHAEL ANTHONY LANGSTON SR. (NPI 1821410630)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1821410630 NPI number — MR. MICHAEL ANTHONY LANGSTON SR.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
LANGSTON
Provider First Name:
MICHAEL
Provider Middle Name:
ANTHONY
Provider Name Prefix Text:
MR.
Provider Name Suffix Text:
SR.
Provider Credential Text:
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
LANGSTON
Provider Other First Name:
JULIET
Provider Other Middle Name:
Provider Other Name Prefix Text:
MRS.
Provider Other Name Suffix Text:
Provider Other Credential Text:
RN
Provider Other Last Name Type Code:
5

NPI Number Information

NPI Number:
1821410630
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
01/13/2014
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
905 OGLETHORPE LN
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
SAVANNAH
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
76227-7908
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
469-337-4817
Provider Business Mailing Address Fax Number:
469-481-2642

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
905 OGLETHORPE LN
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
SAVANNAH
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
76227-7908
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
469-337-4817
Provider Business Practice Location Address Fax Number:
469-481-2642
Provider Enumeration Date:
01/13/2014

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: 251E00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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