Provider Demographics
NPI:1891027199
Name:LONG, ADAM W (CRNA)
Entity type:Individual
Prefix:
First Name:ADAM
Middle Name:W
Last Name:LONG
Suffix:
Gender:M
Credentials:CRNA
Other - Prefix:
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Other - Middle Name:
Other - Last Name:
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Mailing Address - Street 1:PO BOX 1389
Mailing Address - Street 2:
Mailing Address - City:HUNTSVILLE
Mailing Address - State:AL
Mailing Address - Zip Code:35807-0389
Mailing Address - Country:US
Mailing Address - Phone:205-979-5882
Mailing Address - Fax:205-979-1248
Practice Address - Street 1:911 BIG COVE RD SE
Practice Address - Street 2:
Practice Address - City:HUNTSVILLE
Practice Address - State:AL
Practice Address - Zip Code:35801-3750
Practice Address - Country:US
Practice Address - Phone:205-979-5882
Practice Address - Fax:205-979-1248
Is Sole Proprietor?:No
Enumeration Date:2010-02-11
Last Update Date:2010-04-05
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
AL1-105356367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL117007Medicaid
511-02950OtherBC BS OF AL
AL1891027199OtherTRICARE
AL102I438059Medicare PIN