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NPI Code Detail

MEDICARE: DREW JORDAN LONG

MEDICARE: DREW JORDAN LONG
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1247100000XRadiologic TechnologistOH

General Provider Information

NPI Number : 1548115645
Entity Type Code : Individual
Provider Name (Legal Business Name) : DREW JORDAN LONG
Provider Business Mailing Address
First Line : 17273 STATE ROUTE 104
Second Line :
City : CHILLICOTHEE
State : OH
Zip : 45601-9718
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 17273 STATE ROUTE 104
Second Line :
City : CHILLICOTHEE
State : OH
Zip : 45601-9718
Country : US
Telephone Number : 740-773-1141
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 03/03/2026
Last Update Date : 03/03/2026

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Directions to “ DREW JORDAN LONG ” Practice Location

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