TIM LONG M.D. PSC NPI 1417057902

NPI Information

NPI: 1417057902
Provider Name: TIM LONG M.D., PSC
Classification: Clinic/Center - 261QP2300X
Entity Type: Organization

Specialization: Primary Care

CLIA Number: 18D1000308

Address:
1320 ANDREA ST
BOWLING GREEN, KY
ZIP 42104
Phone: (270) 746-5455
Get Directions

TIM LONG M.D., PSC is a primary care clinic center in Bowling Green, KY. TIM LONG M.D., PSC NPI is 1417057902. The provider is registered as an organization entity type.

The provider's business location address is:

1320 ANDREA ST
BOWLING GREEN, KY
ZIP 42104-334
Phone: (270) 746-5455
Fax: (270) 746-5688

The provider's authorized official is Timothy R. Long .
The authorized official title is President and has the following contact phone number (270) 746-5455.

The CLIA number assigned to this NPI record is 18D1000308 - physician office with a certificate type of Certificate of Accreditation.

The enumeration date for this NPI number is 9/24/2006 and was last updated on 3/6/2008.

Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

No.	Taxonomy Code	Taxonomy Clasification	Taxonomy Specialization	License Number	License State	Primary
1	261Q00000X	Clinic/Center				No
2	261QP2300X	Clinic/Center	Primary Care			Yes

Other Identifiers

The following information regarding additional identifiers associated to this NPI record includes the other identifier number, identifier type, identifier state and issuer.

No.	Other Provider Identifier	Other Provider Identifier Type	Other Provider Identifier State	Other Provider Identifier Issuer
1	000000216368	OTHER		BC/BS
2	7123	MEDICARE PIN
3	65936585	MEDICAID	KENTUCKY
4	DA8524	OTHER		MEDICARE RAILROAD

What is NPI?

NPI stands for National Provider Identifier. The NPI is a 10-digit identification number that is completely unique. The NPI number by itself does not contain any identifiable information such as a provider’s speciality or location. The NPI is assigned to individuals or organizacions for their lifespan and it is independent of key provider information type updates like a change of practices, location or speciality.

This page was last updated on: 11/14/2023

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