1194168930 NPI number — MRS. MARLENA LANGFORD APN-BC

Table of content: MRS. MARLENA LANGFORD APN-BC (NPI 1194168930)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1194168930 NPI number — MRS. MARLENA LANGFORD APN-BC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
LANGFORD
Provider First Name:
MARLENA
Provider Middle Name:
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
APN-BC
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:
1194168930
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
06/14/2022
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 21890
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
BELFAST
Provider Business Mailing Address State Name:
ME
Provider Business Mailing Address Postal Code:
04915-4115
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
502-907-0356
Provider Business Mailing Address Fax Number:
502-919-9780

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
700 KIMBER LANE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
EVANSVILLE
Provider Business Practice Location Address State Name:
IN
Provider Business Practice Location Address Postal Code:
47715-2803
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
812-476-7111
Provider Business Practice Location Address Fax Number:
812-476-7117
Provider Enumeration Date:
04/11/2013

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: 363LA2200X , with the licence number:  3008284 , registered in the state of KY ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 363LA2200X , with the licence number: 71004454A , registered in the state of IN ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 8059404 . This is a "CIGNA" identifier . This identifiers is of the category "OTHER".
  • Identifier: 8703700 . This is a "AETNA PIN" identifier . This identifiers is of the category "OTHER".
  • Identifier: 201178460 , issued by the state of ( IN ) . This identifiers is of the category "MEDICAID".
  • Identifier: 000001083038 . This is a "ANTHEM PIN" identifier . This identifiers is of the category "OTHER".
  • Identifier: 1530528 . This is a "WELLCARE OF KY PROVIDER ID NUMBER" identifier , issued by the state of ( KY ) . This identifiers is of the category "OTHER".
  • Identifier: 7100290800 , issued by the state of ( KY ) . This identifiers is of the category "MEDICAID".
  • Identifier: CS1807800105 . This is a "CARESOURCE ID" identifier . This identifiers is of the category "OTHER".
  • Identifier: 3688482 . This is a "UNITED HEALTHCARE PROVIDER ID NUMBER" identifier . This identifiers is of the category "OTHER".




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