Provider Demographics
NPI:1114181815
Name:LANGE, SCOTT THOMAS (RPA, RRA)
Entity Type:Individual
Prefix:MR
First Name:SCOTT
Middle Name:THOMAS
Last Name:LANGE
Suffix:
Gender:M
Credentials:RPA, RRA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9745 S CLINTON TRL
Mailing Address - Street 2:
Mailing Address - City:EATON RAPIDS
Mailing Address - State:MI
Mailing Address - Zip Code:48827-8582
Mailing Address - Country:US
Mailing Address - Phone:517-490-5690
Mailing Address - Fax:
Practice Address - Street 1:1535 GULL RD STE 200
Practice Address - Street 2:
Practice Address - City:KALAMAZOO
Practice Address - State:MI
Practice Address - Zip Code:49048-1638
Practice Address - Country:US
Practice Address - Phone:269-388-6350
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-07-11
Last Update Date:2019-10-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes243U00000XTechnologists, Technicians & Other Technical Service ProvidersRadiology Practitioner Assistant
No2471C1101XTechnologists, Technicians & Other Technical Service ProvidersRadiologic TechnologistCardiovascular-Interventional Technology