MEDICARE: C.W. LONG ENTERPRISES, INC.

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
1	208D00000X	General Practice Physician	29119	MO

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1811122864
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	C.W. LONG ENTERPRISES, INC.

Provider Business Mailing Address
First Line	:	PO BOX 140
Second Line	:
City	:	BUTLER
State	:	MO
Zip	:	64730-0140
Country	:	US
Telephone Number	:	660-679-3140
Fax Number	:	660-679-3468

Provider Business Practice Location Address
First Line	:	200 W CHESTNUT ST
Second Line	:
City	:	BUTLER
State	:	MO
Zip	:	64730-1554
Country	:	US
Telephone Number	:	660-679-3140
Fax Number	:	660-679-3468

Authorized Official
Title or Position	:	OWNER/PHYSICAIN
Name	:	DR. CURTIS W. LONG
Credential	:	M.D.
Telephone Number	:	660-679-3140

Provider Enumeration Date	:	05/20/2009
Last Update Date	:	05/20/2009

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