Organization
NP GROUP OF TIM LONG MD PSC
Active
Parent organization
TIM LONG MD PSC
Organization subpart
Yes
Provider details
NPI number
Legal business name
TIM LONG MD PSC
Authorized official
DR. TIMOTHY LONG MD (PRESIDENT)
(270) 746-5455
Entity
Organization
Contact information
Practice address
1320 ANDREA ST, BOWLING GREEN, KY 42104-3334
(270) 746-5455
(270) 746-5688
Mailing address
1320 ANDREA ST, BOWLING GREEN, KY 42104-3334
Taxonomy
Speciality
Code
Description
License number
State
363LF0000X
Family Nurse Practitioner
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1417057902
—
KY
Enumeration date
05/16/2008
Last updated
05/16/2008
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