Healthcare Provider Details

I. General information

NPI: 1356268023
Provider Name (Legal Business Name): LONG MEDICAL PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/02/2026
Last Update Date: 07/24/2026
Certification Date: 07/24/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2265 DESOTO ST
IDAHO FALLS ID
83404-7540
US

IV. Provider business mailing address

2265 DESOTO ST
IDAHO FALLS ID
83404-7540
US

V. Phone/Fax

Practice location:
  • Phone: 208-569-7139
  • Fax:
Mailing address:
  • Phone: 208-523-6773
  • Fax: 833-468-5139

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. MICHAEL THOMAS LONG
Title or Position: OWNER
Credential: DO
Phone: 208-569-7139