1598928376 NPI number — DR. EMILY MARIE LANGE MD

Table of content: DR. EMILY MARIE LANGE MD (NPI 1598928376)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1598928376 NPI number — DR. EMILY MARIE LANGE MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
LANGE
Provider First Name:
EMILY
Provider Middle Name:
MARIE
Provider Name Prefix Text:
DR.
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:
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:
1598928376
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/08/2015
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 3755
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
OMAHA
Provider Business Mailing Address State Name:
NE
Provider Business Mailing Address Postal Code:
68103-0755
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
402-354-2100
Provider Business Mailing Address Fax Number:
402-354-2155

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
201 RIDGE ST
Provider Second Line Business Practice Location Address:
STE 312
Provider Business Practice Location Address City Name:
COUNCIL BLUFFS
Provider Business Practice Location Address State Name:
IA
Provider Business Practice Location Address Postal Code:
51503-4643
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
712-396-7880
Provider Business Practice Location Address Fax Number:
712-396-7885
Provider Enumeration Date:
07/02/2008

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: 207V00000X , with the licence number:  5861 , registered in the state of NE ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 207V00000X , with the licence number: 41994 , 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: 10026211300 , issued by the state of ( NE ) . This identifiers is of the category "MEDICAID".
  • Identifier: 1598928376 , issued by the state of ( IA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 47068731777 , issued by the state of ( NE ) . This identifiers is of the category "MEDICAID".




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