Provider Demographics
NPI:1801890686
Name:LONG, HERBERT W (MD)
Entity type:Individual
Prefix:
First Name:HERBERT
Middle Name:W
Last Name:LONG
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 936
Mailing Address - Street 2:
Mailing Address - City:LONDON
Mailing Address - State:KY
Mailing Address - Zip Code:40743-0936
Mailing Address - Country:US
Mailing Address - Phone:606-330-7818
Mailing Address - Fax:606-330-7825
Practice Address - Street 1:417 RIVER DR
Practice Address - Street 2:
Practice Address - City:IRVINE
Practice Address - State:KY
Practice Address - Zip Code:40336-1272
Practice Address - Country:US
Practice Address - Phone:606-723-0399
Practice Address - Fax:606-723-0379
Is Sole Proprietor?:Yes
Enumeration Date:2005-06-09
Last Update Date:2019-08-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY31482207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY61-1341297OtherTRICARE
KY5211107OtherAETNA ID
KY000889063OtherHUMANA
KY64314826Medicaid
KY000000052184OtherANTHEM BCBS ID
KY01-00767OtherUNITED HEATLH CARE
KY1166070OtherCHA HEALTH
KY2768OtherBLUEGRASS FAMILY HEALTH
KY35001262Medicaid
KY1532269OtherUMWA
KY64314826Medicaid
KY000000052184OtherANTHEM BCBS ID
KY35001262Medicaid
KY000889063OtherHUMANA