Provider Demographics
NPI:1578955928
Name:RAY H TANGUNAN
Entity Type:Organization
Organization Name:RAY H TANGUNAN
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BILLING MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:DULCE
Authorized Official - Middle Name:A
Authorized Official - Last Name:TANGUNAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:863-314-8440
Mailing Address - Street 1:6801 US HIGHWAY 27 N STE B4
Mailing Address - Street 2:
Mailing Address - City:SEBRING
Mailing Address - State:FL
Mailing Address - Zip Code:33870-1000
Mailing Address - Country:US
Mailing Address - Phone:863-314-8440
Mailing Address - Fax:
Practice Address - Street 1:6801 US HIGHWAY 27 N STE B4
Practice Address - Street 2:
Practice Address - City:SEBRING
Practice Address - State:FL
Practice Address - Zip Code:33870-1000
Practice Address - Country:US
Practice Address - Phone:863-314-8440
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:RAY H TANGUNAN
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2015-02-23
Last Update Date:2015-02-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME56385207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL037866703Medicaid
FL08786OtherFLORIDA BLUE
FL08786OtherFLORIDA BLUE