1346662103 NPI number — MRS. CASEY WHITE LANGEL PA

Table of content: MRS. CASEY WHITE LANGEL PA (NPI 1346662103)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1346662103 NPI number — MRS. CASEY WHITE LANGEL PA

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
LANGEL
Provider First Name:
CASEY
Provider Middle Name:
WHITE
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
PA
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
WHITE
Provider Other First Name:
CASEY
Provider Other Middle Name:
G
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
PA
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1346662103
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
09/06/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
3300 S FISKE BLVD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
ROCKLEDGE
Provider Business Mailing Address State Name:
FL
Provider Business Mailing Address Postal Code:
32955-4306
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
321-723-7716
Provider Business Mailing Address Fax Number:
321-723-0604

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2222 S HARBOR CITY BLVD
Provider Second Line Business Practice Location Address:
SUITE 610
Provider Business Practice Location Address City Name:
MELBOURNE
Provider Business Practice Location Address State Name:
FL
Provider Business Practice Location Address Postal Code:
32901-5594
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
321-723-7716
Provider Business Practice Location Address Fax Number:
321-723-0604
Provider Enumeration Date:
01/14/2014

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: 363A00000X , with the licence number:  PA9107661 , 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: 010554500 , issued by the state of ( FL ) . This identifiers is of the category "MEDICAID".
  • Identifier: OV542 . This is a "MEDICARE HF" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".
  • Identifier: 010554500 . This is a "Florida Medicaid Provider ID" identifier , issued by the state of ( FL ) . This identifiers is of the category "MEDICAID".




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