Basic Information
| Provider Information | |||||||||
| NPI: | 1114995354 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | LANG | ||||||||
| FirstName: | THOMAS | ||||||||
| MiddleName: | M | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 509 MEDTECH PKWY | ||||||||
| Address2: | SUITE 100 | ||||||||
| City: | JOHNSON CITY | ||||||||
| State: | TN | ||||||||
| PostalCode: | 37604 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4239522122 | ||||||||
| FaxNumber: | 4239522145 | ||||||||
| Practice Location | |||||||||
| Address1: | 100 15TH ST NW | ||||||||
| Address2: | SUITE A | ||||||||
| City: | NORTON | ||||||||
| State: | VA | ||||||||
| PostalCode: | 24273 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2764391840 | ||||||||
| FaxNumber: | 2764391845 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 03/14/2006 | ||||||||
| LastUpdateDate: | 03/31/2016 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207P00000X | 036-094065 | IL | N | Allopathic & Osteopathic Physicians | Emergency Medicine | 207P00000X | 35.099885 | OH | N | Allopathic & Osteopathic Physicians | Emergency Medicine | 207P00000X | MD00021559 | WA | N | Allopathic & Osteopathic Physicians | Emergency Medicine | 207R00000X | 0101250560 | VA | Y | Allopathic & Osteopathic Physicians | Internal Medicine | 207R00000X | 47911 | TN | N | Allopathic & Osteopathic Physicians | Internal Medicine |
ID Information
| ID | Type | State | Issuer | Description | 1487892378 | 01 | IL | BCBS | OTHER | 8188732 | 05 | WA | MEDICAID | 036094065-7 | 05 | IL | MEDICAID | 036094065-8 | 05 | IL | MEDICAID | 930115946 | 01 | RAILROAD MEDICARE | OTHER |