Organization
HERBERT W LONG
Active
Organization subpart
No
Provider details
NPI number
Authorized official
HERBERT W LONG MD (PHYISICAN)
(606) 723-0399
Entity
Organization
Contact information
Practice address
417 RIVER DRIVE, IRVINE, KY 40336
(606) 723-0399
(606) 723-0379
Mailing address
417 RIVER DRIVE, IRVINE, KY 40336
(606) 723-0399
(606) 723-0379
Taxonomy
Speciality
Code
Description
License number
State
261QR1300X
Rural Health Clinic/Center
Primary
31482
KY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
31482
LICENSE
KY
05
—
35001262
—
KY
Enumeration date
05/02/2007
Last updated
09/16/2010
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