Provider Demographics
NPI:1417144403
Name:EUGENE E. LANGEVIN,D.O.,P.C.
Entity Type:Organization
Organization Name:EUGENE E. LANGEVIN,D.O.,P.C.
Other - Org Name:CARDIOVASCULAR MEDICINE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRACTICE MANAGER/CORPORATION SEC
Authorized Official - Prefix:MRS
Authorized Official - First Name:JUDY
Authorized Official - Middle Name:A
Authorized Official - Last Name:LANGEVIN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:417-623-6343
Mailing Address - Street 1:1531 W 32ND ST
Mailing Address - Street 2:SUITE 208
Mailing Address - City:JOPLIN
Mailing Address - State:MO
Mailing Address - Zip Code:64804-1611
Mailing Address - Country:US
Mailing Address - Phone:417-623-6343
Mailing Address - Fax:417-623-6424
Practice Address - Street 1:1531 W 32ND ST
Practice Address - Street 2:SUITE 208
Practice Address - City:JOPLIN
Practice Address - State:MO
Practice Address - Zip Code:64804-1611
Practice Address - Country:US
Practice Address - Phone:417-623-6343
Practice Address - Fax:417-623-6424
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-10-03
Last Update Date:2007-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO32881207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular DiseaseGroup - Single Specialty