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General NPI Number Information
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NPI Number | 1356268023
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Entity Type | Organization
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Legal Business Name | LONG FAMILY MEDICINE
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Dates
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Enumeration Date | 07/02/2026
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Last Update Date | 07/02/2026
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Provider Practice Location Address
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Address Line | 2265 DESOTO ST
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City | IDAHO FALLS
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State | ID
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Zip | 83404-7540
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Country | US
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Telephone | 208-569-7139
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Fax |
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Provider Business Mailing Address
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Address Line | 2265 DESOTO ST
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City | IDAHO FALLS
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State | ID
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Zip | 83404-7540
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Country | US
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Telephone | 208-569-7139
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | DR. MICHAEL THOMAS LONG
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Credential | DO
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Telephone | 208-569-7139
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number |
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License Number State |
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