Provider Demographics
NPI:1164073524
Name:TANGI WELLNESS & HEALTH
Entity Type:Organization
Organization Name:TANGI WELLNESS & HEALTH
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRACTICE ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:KELLY
Authorized Official - Middle Name:
Authorized Official - Last Name:OLLER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:985-345-1555
Mailing Address - Street 1:906 C M FAGAN DR STE B3
Mailing Address - Street 2:
Mailing Address - City:HAMMOND
Mailing Address - State:LA
Mailing Address - Zip Code:70403-6056
Mailing Address - Country:US
Mailing Address - Phone:985-345-1555
Mailing Address - Fax:985-345-1558
Practice Address - Street 1:906 C M FAGAN DR STE B3
Practice Address - Street 2:
Practice Address - City:HAMMOND
Practice Address - State:LA
Practice Address - Zip Code:70403-6056
Practice Address - Country:US
Practice Address - Phone:985-345-1555
Practice Address - Fax:985-345-1558
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-09-26
Last Update Date:2020-01-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR1300XAmbulatory Health Care FacilitiesClinic/CenterRural Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
LAMM5245697OtherDEA
LACDS.054690-APNOtherCDS
LARN147996OtherRN