Provider Demographics
NPI:1811122864
Name:C.W. LONG ENTERPRISES, INC.
Entity type:Organization
Organization Name:C.W. LONG ENTERPRISES, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PHYSICAIN
Authorized Official - Prefix:DR
Authorized Official - First Name:CURTIS
Authorized Official - Middle Name:W
Authorized Official - Last Name:LONG
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:660-679-3140
Mailing Address - Street 1:PO BOX 140
Mailing Address - Street 2:
Mailing Address - City:BUTLER
Mailing Address - State:MO
Mailing Address - Zip Code:64730-0140
Mailing Address - Country:US
Mailing Address - Phone:660-679-3140
Mailing Address - Fax:660-679-3468
Practice Address - Street 1:200 W CHESTNUT ST
Practice Address - Street 2:
Practice Address - City:BUTLER
Practice Address - State:MO
Practice Address - Zip Code:64730-1554
Practice Address - Country:US
Practice Address - Phone:660-679-3140
Practice Address - Fax:660-679-3468
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-05-20
Last Update Date:2009-05-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO29119208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral PracticeGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO200645901Medicaid
MO200645901Medicaid