Provider Demographics
NPI:1548466097
Name:LANGENBERG PLLC
Entity type:Organization
Organization Name:LANGENBERG PLLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:MARK
Authorized Official - Middle Name:TAYLOR
Authorized Official - Last Name:LANGENBERG
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:931-823-5681
Mailing Address - Street 1:P. O. BOX 609
Mailing Address - Street 2:
Mailing Address - City:LIVINGSTON
Mailing Address - State:TN
Mailing Address - Zip Code:38570
Mailing Address - Country:US
Mailing Address - Phone:931-823-5681
Mailing Address - Fax:931-823-8203
Practice Address - Street 1:500 W MAIN ST
Practice Address - Street 2:
Practice Address - City:LIVINGSTON
Practice Address - State:TN
Practice Address - Zip Code:38570-1718
Practice Address - Country:US
Practice Address - Phone:931-823-5681
Practice Address - Fax:931-823-8203
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-06-22
Last Update Date:2007-08-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN35093208000000X, 207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty
No208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN3379686Medicaid
TN3379686Medicaid
TNH65407Medicare UPIN