Active NPI
Larry William Immenschuh, RDLD
- Registered Dietitian
- Fort Sill, OK
National Provider Identifier
1699914168
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Registered Dietitian
- License
- 630
- Practice address
- 3009 N. W. Wilson Street
Fort Sill, OK 73503-9042 - Phone
- (580) 458-2134
- Fax
- (580) 458-2314
- NPI assigned
- Feb 6, 2009
- Sex
- Male
- Sole proprietor
- No
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 |
|---|---|---|---|---|
| Registered Dietitian | 133V00000X | 630 | OK | Primary |
Addresses
Primary practice location
3009 N. W. Wilson Street
Fort Sill, OK 73503-9042
Mailing address
1406 NE Independence Ave
Lawton, OK 73507-3438
Phone (580) 695-3213
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)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 630 | OK | MD | Speech-Language Pathologist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1233878400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1548720000000",
"number": "1699914168",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1406 NE INDEPENDENCE AVE",
"city": "LAWTON",
"state": "OK",
"postal_code": "735073438",
"telephone_number": "580-695-3213"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "3009 N. W. WILSON STREET",
"city": "FORT SILL",
"state": "OK",
"postal_code": "735039042",
"telephone_number": "580-458-2134",
"fax_number": "580-458-2314"
}
],
"practiceLocations": [],
"basic": {
"last_name": "IMMENSCHUH",
"first_name": "LARRY",
"middle_name": "WILLIAM",
"name_prefix": "Mr.",
"credential": "RDLD",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2009-02-06",
"last_updated": "2019-01-29",
"status": "A"
},
"taxonomies": [
{
"code": "133V00000X",
"taxonomy_group": "",
"desc": "Dietitian, Registered",
"state": "OK",
"license": "630",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Fort Sill, OK
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 29, 2019; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.