1255380945 NPI number — DR. STEPHEN M LANGE PHD

Table of content: DR. STEPHEN M LANGE PHD (NPI 1255380945)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1255380945 NPI number — DR. STEPHEN M LANGE PHD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
LANGE
Provider First Name:
STEPHEN
Provider Middle Name:
M
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
PHD
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:
1255380945
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
12/08/2016
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
LAWTON CORRECTIONAL FACILITY
Provider Second Line Business Mailing Address:
8607 SE FLOWERMOUND ROAD
Provider Business Mailing Address City Name:
LAWTON
Provider Business Mailing Address State Name:
OK
Provider Business Mailing Address Postal Code:
73501
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
580-280-7128
Provider Business Mailing Address Fax Number:
405-716-4810

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
LAWTON CORRECTIONAL FACILITY
Provider Second Line Business Practice Location Address:
8607 SE FLOWERMOUND ROAD
Provider Business Practice Location Address City Name:
LAWTON
Provider Business Practice Location Address State Name:
OK
Provider Business Practice Location Address Postal Code:
73501
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
580-280-7128
Provider Business Practice Location Address Fax Number:
405-716-4810
Provider Enumeration Date:
05/09/2006

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: 103G00000X , with the licence number:  PS008789L , registered in the state of PA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 103TC2200X , with the licence number: PS008789L , registered in the state of PA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 103T00000X , with the licence number: PS008789L , registered in the state of PA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 103TA0400X , with the licence number: 1208 , registered in the state of OK ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 103TC0700X , with the licence number: 1208 , registered in the state of OK ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 103TH0100X , with the licence number: 1208 , registered in the state of OK ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 103TS0200X , with the licence number: 1208 , registered in the state of OK ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

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

  • Identifier: 112460809 . This is a "UNITED BEHAVIORAL HEALTH" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 1501224 . This is a "HIGHMARK BLUE SHIELD" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 550010003163 . This is a "PACIFIC BEHAVIORAL HC" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 50011084 . This is a "CAPITAL BLUE CROSS" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".