1861429482 NPI number — TYSON LEE LANGELIERS PA -C, ATC, LAT

Table of content: TYSON LEE LANGELIERS PA -C, ATC, LAT (NPI 1861429482)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1861429482 NPI number — TYSON LEE LANGELIERS PA -C, ATC, LAT

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
LANGELIERS
Provider First Name:
TYSON
Provider Middle Name:
LEE
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
PA -C, ATC, LAT
Provider Gender Code:
M

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:
1861429482
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/12/2018
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 3300
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
LA PINE
Provider Business Mailing Address State Name:
OR
Provider Business Mailing Address Postal Code:
97739-3300
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
541-536-3435
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
51600 HUNTINGTON RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
LA PINE
Provider Business Practice Location Address State Name:
OR
Provider Business Practice Location Address Postal Code:
97739
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
541-536-3435
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
06/27/2006

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: 2255A2300X , with the licence number:  AT-223 , registered in the state of ID ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 363A00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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