Provider Demographics
NPI:1922149020
Name:WILLIAM S. LONGFELLOW, M.D., INC.
Entity Type:Organization
Organization Name:WILLIAM S. LONGFELLOW, M.D., INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:WILLIAM
Authorized Official - Middle Name:STEVEN
Authorized Official - Last Name:LONGFELLOW
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:760-340-6777
Mailing Address - Street 1:71780 SAN JACINTO DR
Mailing Address - Street 2:BLDG. H-1
Mailing Address - City:RANCHO MIRAGE
Mailing Address - State:CA
Mailing Address - Zip Code:92270-5516
Mailing Address - Country:US
Mailing Address - Phone:760-340-6777
Mailing Address - Fax:760-340-1146
Practice Address - Street 1:71780 SAN JACINTO DR
Practice Address - Street 2:BLDG. H-1
Practice Address - City:RANCHO MIRAGE
Practice Address - State:CA
Practice Address - Zip Code:92270-5516
Practice Address - Country:US
Practice Address - Phone:760-340-6777
Practice Address - Fax:760-340-1146
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-09
Last Update Date:2010-06-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA50581207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A505810Medicare ID - Type UnspecifiedMEDICARE ID #