Provider Demographics
NPI:1508424656
Name:LONGEVITY HEALTH PILOTS LLC
Entity Type:Organization
Organization Name:LONGEVITY HEALTH PILOTS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:WILLIAM
Authorized Official - Middle Name:K
Authorized Official - Last Name:KAPP
Authorized Official - Suffix:III
Authorized Official - Credentials:MD
Authorized Official - Phone:573-331-8040
Mailing Address - Street 1:8171 BAY COLONY DR APT 902
Mailing Address - Street 2:
Mailing Address - City:NAPLES
Mailing Address - State:FL
Mailing Address - Zip Code:34108-7564
Mailing Address - Country:US
Mailing Address - Phone:573-331-8040
Mailing Address - Fax:
Practice Address - Street 1:8171 BAY COLONY DR APT 902
Practice Address - Street 2:
Practice Address - City:NAPLES
Practice Address - State:FL
Practice Address - Zip Code:34108-7564
Practice Address - Country:US
Practice Address - Phone:573-331-8040
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-06-04
Last Update Date:2019-06-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral PracticeGroup - Multi-Specialty