Provider Demographics
NPI:1003933649
Name:RANGEL, JESUS (ACA, BC-HIS)
Entity type:Individual
Prefix:
First Name:JESUS
Middle Name:
Last Name:RANGEL
Suffix:
Gender:M
Credentials:ACA, BC-HIS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:925 W LOOP 281
Mailing Address - Street 2:
Mailing Address - City:LONGVIEW
Mailing Address - State:TX
Mailing Address - Zip Code:75604-2918
Mailing Address - Country:US
Mailing Address - Phone:903-247-3444
Mailing Address - Fax:903-247-3853
Practice Address - Street 1:1407 LAGO TRL STE 100
Practice Address - Street 2:
Practice Address - City:LONGVIEW
Practice Address - State:TX
Practice Address - Zip Code:75604-2740
Practice Address - Country:US
Practice Address - Phone:903-247-3444
Practice Address - Fax:903-247-3853
Is Sole Proprietor?:No
Enumeration Date:2007-03-26
Last Update Date:2018-03-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA1164237700000X
TX50606237700000X, 231H00000X, 235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist
Yes237700000XSpeech, Language and Hearing Service ProvidersHearing Instrument Specialist
No235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX610593600OtherDOL-OWCP (WORKERS COMP)
TX1762338-01Medicaid
TX531646OtherBLUE CROSS BLUE SHIELD
TX610593600OtherDOL-OWCP (WORKERS COMP)