1912182015 NPI number — MRS. MARY CAMILLE LAINGEN ATC

Table of content: MRS. MARY CAMILLE LAINGEN ATC (NPI 1912182015)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1912182015 NPI number — MRS. MARY CAMILLE LAINGEN ATC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
LAINGEN
Provider First Name:
MARY
Provider Middle Name:
CAMILLE
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
ATC
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
EATON
Provider Other First Name:
MARY
Provider Other Middle Name:
CAMILLE
Provider Other Name Prefix Text:
MS.
Provider Other Name Suffix Text:
Provider Other Credential Text:
ATC
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1912182015
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
01/08/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
168 E LONGVIEW AVE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
COLUMBUS
Provider Business Mailing Address State Name:
OH
Provider Business Mailing Address Postal Code:
43202-1236
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
419-778-9018
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
535 IRVING SCHOTTENSTEIN DR
Provider Second Line Business Practice Location Address:
WOODY HAYES ATHLETIC CENTER
Provider Business Practice Location Address City Name:
COLUMBUS
Provider Business Practice Location Address State Name:
OH
Provider Business Practice Location Address Postal Code:
43210-1044
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
614-292-1165
Provider Business Practice Location Address Fax Number:
614-292-3258
Provider Enumeration Date:
01/08/2008

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: 2255A2300X , with the licence number:  AT-2710 , registered in the state of OH ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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