Provider Demographics
NPI:1356311914
Name:LONGABAUGH, JAMES ALLEN (DO)
Entity Type:Individual
Prefix:DR
First Name:JAMES
Middle Name:ALLEN
Last Name:LONGABAUGH
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:P.O. BOX 229
Mailing Address - Street 2:
Mailing Address - City:SABETHA
Mailing Address - State:KS
Mailing Address - Zip Code:66534
Mailing Address - Country:US
Mailing Address - Phone:785-284-2141
Mailing Address - Fax:785-284-0063
Practice Address - Street 1:1115 MAIN
Practice Address - Street 2:
Practice Address - City:SABETHA
Practice Address - State:KS
Practice Address - Zip Code:66534
Practice Address - Country:US
Practice Address - Phone:785-284-2141
Practice Address - Fax:785-284-0063
Is Sole Proprietor?:No
Enumeration Date:2006-01-25
Last Update Date:2021-01-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE310208600000X
KS05-25864207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS100236940CMedicaid
G20295Medicare UPIN
101556Medicare PIN