1124006119 NPI number — INDIRA S LANIG MD

Table of content: INDIRA S LANIG MD (NPI 1124006119)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1124006119 NPI number — INDIRA S LANIG MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
LANIG
Provider First Name:
INDIRA
Provider Middle Name:
S
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
MD
Provider Gender Code:
F

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:
1124006119
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/21/2022
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
6834 S UNIVERSITY BLVD
Provider Second Line Business Mailing Address:
#122
Provider Business Mailing Address City Name:
CENTENNIAL
Provider Business Mailing Address State Name:
CO
Provider Business Mailing Address Postal Code:
80122-1515
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
303-761-1215
Provider Business Mailing Address Fax Number:
303-762-1701

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
4401 UNION ST
Provider Second Line Business Practice Location Address:
NORTHERN COLORADO REHABILITATION HOSPITAL
Provider Business Practice Location Address City Name:
JOHNSTOWN
Provider Business Practice Location Address State Name:
CO
Provider Business Practice Location Address Postal Code:
80534-2800
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
303-761-1215
Provider Business Practice Location Address Fax Number:
303-762-1701
Provider Enumeration Date:
01/09/2006

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: 208100000X , with the licence number:  G8233 , registered in the state of TX ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 2081P0004X , with the licence number: DR0029314 , registered in the state of CO ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 208100000X , with the licence number: DR0029314 , registered in the state of CO ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 208100000X , with the licence number: MD60610353 , registered in the state of WA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

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

  • Identifier: 100261155-00 , issued by the state of ( NE ) . This identifiers is of the category "MEDICAID".
  • Identifier: 1124006119 , issued by the state of ( WY ) . This identifiers is of the category "MEDICAID".
  • Identifier: 01293141 , issued by the state of ( CO ) . This identifiers is of the category "MEDICAID".