1568506988 NPI number — LORRAINE MARIE TANGEN MD

Table of content: JOSEPH NOAH ABERGEL (NPI 1578300398)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1568506988 NPI number — LORRAINE MARIE TANGEN MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
TANGEN
Provider First Name:
LORRAINE
Provider Middle Name:
MARIE
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:
TANGEN
Provider Other First Name:
LORI
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
MA
Provider Other Last Name Type Code:
5

NPI Number Information

NPI Number:
1568506988
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
01/11/2024
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
AMG -ESTHERVILLE 926 N 8TH ST
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
ESTHERVILLE
Provider Business Mailing Address State Name:
IA
Provider Business Mailing Address Postal Code:
51334
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
712-362-6501
Provider Business Mailing Address Fax Number:
712-362-7190

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
AMG -ESTHERVILLE 926 N 8TH ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
ESTHERVILLE
Provider Business Practice Location Address State Name:
IA
Provider Business Practice Location Address Postal Code:
51334
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
712-362-6501
Provider Business Practice Location Address Fax Number:
712-362-7190
Provider Enumeration Date:
02/18/2007

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: 207Q00000X , with the licence number:  MD-50220 , registered in the state of IA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 000010002487 . This is a "BLUE SHIELD OF IDAHO" identifier , issued by the state of ( ID ) . This identifiers is of the category "OTHER".
  • Identifier: DP070 . This is a "BLUE CROSS OF IDAHO" identifier , issued by the state of ( ID ) . This identifiers is of the category "OTHER".
  • Identifier: 003978700 , issued by the state of ( ID ) . This identifiers is of the category "MEDICAID".
  • Identifier: 820227163G0020 . This is a "TRICARE" identifier , issued by the state of ( ID ) . This identifiers is of the category "OTHER".
  • Identifier: 1129286 . This is a "STATE INSURANCE FUND" identifier , issued by the state of ( ID ) . This identifiers is of the category "OTHER".