MEDICARE: DR. JOSEPH M. LONGNECKER, D.O., 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	261QP2300X	Primary Care Clinic/Center	20A3180	CA

General Provider Information

NPI Number	:	1124322656
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	DR. JOSEPH M. LONGNECKER, D.O., INC

Provider Business Mailing Address
First Line	:	1041 E. YORBA LINDA BLVD.
Second Line	:	SUITE 306
City	:	PLACENTIA
State	:	CA
Zip	:	92870-0000
Country	:	US
Telephone Number	:	714-577-9500
Fax Number	:	714-577-9504

Provider Business Practice Location Address
First Line	:	1041 E. YORBA LINDA BLVD.
Second Line	:	SUITE 306
City	:	PLACENTIA
State	:	CA
Zip	:	92870-0000
Country	:	US
Telephone Number	:	714-577-9500
Fax Number	:	714-577-9504

Authorized Official
Title or Position	:	OWNER/PHYSICIAN
Name	:	DR. JOSEPH MILTON LONGNECKER
Credential	:	D.O.
Telephone Number	:	714-577-9500

Provider Enumeration Date	:	12/23/2010
Last Update Date	:	03/21/2011

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