Mr Carl W Lange Iv, PA is a medicare enrolled "Physician Assistant" in Houston, Missouri. His current practice location is
1337 S Sam Houston Blvd, Houston, Missouri. You can reach out to his office (for appointments etc.) via phone at
(417) 967-5435.
Mr Carl W Lange Iv is licensed to practice in Missouri (license number 2014004500) and he also participates in the medicare program. He does not accept medicare assignments directly but he may accept medicare through third-party (refer to Reassignment section below) and may also prescribe medicare part D drugs. His NPI Number is 1700200458.
Provider's Profile
Full Name | Mr Carl W Lange Iv |
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Gender | Male |
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Speciality | Physician Assistant |
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Location | 1337 S Sam Houston Blvd, Houston, Missouri |
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Accepts Medicare Assignments | Medicare enrolled and may accept medicare through third-party reassignment. May prescribe medicare part D drugs. |
NPI Data:
- NPI Number: 1700200458
- Provider Enumeration Date: 02/14/2014
- Last Update Date: 02/14/2014
Medicare PECOS Information:
- PECOS PAC ID: 9931330453
- Enrollment ID: I20140326002311
Medical Identifiers
Medical identifiers for Mr Carl W Lange Iv such as npi, medicare ID, medicare PIN, medicaid, etc.
Identifier | Type | State | Issuer |
1700200458 | NPI | - | NPPES |
1700200458 | Medicaid | MO | |
26D0889777 | Other | MO | CLIA |
Medical Taxonomies and Licenses
Taxonomy | Type | License (State) | Status |
363A00000X | Physician Assistant | 2014004500 (Missouri) | Primary |
Medicare Part D Prescriber Enrollment
Any physician or other eligible professional who prescribes Part D drugs must either enroll in the Medicare program or opt out in order to prescribe drugs to their patients with Part D prescription drug benefit plans. Mr Carl W Lange Iv is
enrolled with medicare and thus, if eligible, can prescribe medicare part D drugs to patients with medicare part D benefits.
Mailing Address and Practice Location
Mailing Address | Practice Location Address |
Mr Carl W Lange Iv, PA 1337 S Sam Houston Blvd, Houston, MO 65483-2046 Ph: (417) 967-5435 | Mr Carl W Lange Iv, PA 1337 S Sam Houston Blvd, Houston, MO 65483-2046 Ph: (417) 967-5435 |
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