Active NPI
Mitchell Jay Lang
- Athletic Trainer
- Jamestown, ND
National Provider Identifier
1376953885
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Athletic Trainer
- License
- 091-91
- Practice address
- 1105 4TH Ave NE
Jamestown, ND 58401-3229 - Phone
- (701) 252-3467
- Fax
- (701) 253-4318
- NPI assigned
- May 6, 2014
- Sex
- Male
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Athletic Trainer | 2255A2300X | 091-91 | ND | Primary |
Addresses
Primary practice location
1105 4TH Ave NE
Jamestown, ND 58401-3229
Mailing address
1105 4TH Ave NE
Jamestown, ND 58401-3229
Phone (701) 252-3467
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 091-91 | ND | MD | Athletic Trainer |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1399334400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1399334400000",
"number": "1376953885",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1105 4TH AVE NE",
"city": "JAMESTOWN",
"state": "ND",
"postal_code": "584013229",
"telephone_number": "701-252-3467",
"fax_number": "701-253-4318"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1105 4TH AVE NE",
"city": "JAMESTOWN",
"state": "ND",
"postal_code": "584013229",
"telephone_number": "701-252-3467",
"fax_number": "701-253-4318"
}
],
"practiceLocations": [],
"basic": {
"last_name": "LANG",
"first_name": "MITCHELL",
"middle_name": "JAY",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2014-05-06",
"last_updated": "2014-05-06",
"status": "A"
},
"taxonomies": [
{
"code": "2255A2300X",
"taxonomy_group": "",
"desc": "Specialist/Technologist, Athletic Trainer",
"state": "ND",
"license": "091-91",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Jamestown, ND
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 6, 2014; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.