Healthcare Provider Details

I. General information

NPI: 1811122864
Provider Name (Legal Business Name): C.W. LONG ENTERPRISES, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/20/2009
Last Update Date: 05/20/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

200 W CHESTNUT ST
BUTLER MO
64730-1554
US

IV. Provider business mailing address

PO BOX 140
BUTLER MO
64730-0140
US

V. Phone/Fax

Practice location:
  • Phone: 660-679-3140
  • Fax: 660-679-3468
Mailing address:
  • Phone: 660-679-3140
  • Fax: 660-679-3468

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License Number29119
License Number StateMO

VIII. Authorized Official

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