Provider Demographics
NPI:1851364665
Name:LANGBEHN, BOBBI L (PA-C)
Entity Type:Individual
Prefix:
First Name:BOBBI
Middle Name:L
Last Name:LANGBEHN
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:BOBBI
Other - Middle Name:L
Other - Last Name:JACOBSEN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PA-C
Mailing Address - Street 1:PO BOX 6020
Mailing Address - Street 2:
Mailing Address - City:RAPID CITY
Mailing Address - State:SD
Mailing Address - Zip Code:57709-6020
Mailing Address - Country:US
Mailing Address - Phone:605-343-7208
Mailing Address - Fax:
Practice Address - Street 1:3615 5TH ST
Practice Address - Street 2:SUITE 101
Practice Address - City:RAPID CITY
Practice Address - State:SD
Practice Address - Zip Code:57701-6014
Practice Address - Country:US
Practice Address - Phone:605-343-7208
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-02-10
Last Update Date:2017-03-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SD576363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
SDS111743Medicare PIN
SD6827460Medicaid
SD100023Medicare ID - Type Unspecified