Organization
TIM LONG M.D., PSC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. TIMOTHY R. LONG M.D. (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
(270) 746-5455
(270) 746-5688
Taxonomy
Speciality
Code
Description
License number
State
261Q00000X
Clinic/Center
—
—
261QP2300X
Primary Care Clinic/Center
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000000216368
BC/BS
—
05
—
65936585
—
KY
01
—
DA8524
MEDICARE RAILROAD
—
Enumeration date
09/24/2006
Last updated
03/06/2008
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