Provider Demographics
NPI:1710681267
Name:JAMIE LYNN LONGHURST
Entity Type:Organization
Organization Name:JAMIE LYNN LONGHURST
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:JAMIE
Authorized Official - Middle Name:
Authorized Official - Last Name:LONGHURST
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:269-248-6401
Mailing Address - Street 1:800 INDUSTRIAL RD
Mailing Address - Street 2:
Mailing Address - City:MARSHALL
Mailing Address - State:MI
Mailing Address - Zip Code:49068-1743
Mailing Address - Country:US
Mailing Address - Phone:269-248-6401
Mailing Address - Fax:269-233-5265
Practice Address - Street 1:800 INDUSTRIAL RD
Practice Address - Street 2:
Practice Address - City:MARSHALL
Practice Address - State:MI
Practice Address - Zip Code:49068-1743
Practice Address - Country:US
Practice Address - Phone:269-248-6401
Practice Address - Fax:269-233-5265
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-03-29
Last Update Date:2023-08-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care