Provider Demographics
NPI:1730639931
Name:AM LONGLEY HEALTH CENTER PC
Entity Type:Organization
Organization Name:AM LONGLEY HEALTH CENTER PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:
Authorized Official - Last Name:KNEEBONE
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:207-725-4556
Mailing Address - Street 1:42 INDIAN REST RD
Mailing Address - Street 2:
Mailing Address - City:HARPSWELL
Mailing Address - State:ME
Mailing Address - Zip Code:04079-3737
Mailing Address - Country:US
Mailing Address - Phone:207-725-4556
Mailing Address - Fax:207-725-4979
Practice Address - Street 1:42 INDIAN REST RD
Practice Address - Street 2:
Practice Address - City:HARPSWELL
Practice Address - State:ME
Practice Address - Zip Code:04079-3737
Practice Address - Country:US
Practice Address - Phone:207-725-4556
Practice Address - Fax:207-725-4979
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-10-12
Last Update Date:2016-10-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MEDO1335204D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes204D00000XAllopathic & Osteopathic PhysiciansNeuromusculoskeletal Medicine & OMMGroup - Single Specialty