| Mary I Long | |
|
114 E 5th St Natchitoches LA 71457-5725 | |
| (318) 354-9348 | |
| (318) 354-9269 |
| Full Name | Mary I Long |
|---|---|
| Speciality | Internal Medicine |
| Location | 114 E 5th St, Natchitoches, Louisiana |
| Authorized Official Name and Position | Mary Long (OWNER / PROVIDER) |
| Authorized Official Contact | 3183549348 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Mary I Long 114 E 5th St Natchitoches LA 71457-5725 Ph: (318) 354-9348 | Mary I Long 114 E 5th St Natchitoches LA 71457-5725 Ph: (318) 354-9348 |
| NPI Number | 1932425337 |
|---|---|
| Provider Enumeration Date | 04/12/2010 |
| Last Update Date | 04/12/2010 |
| Medicare PECOS PAC ID | 3274664123 |
|---|---|
| Medicare Enrollment ID | O20100622000240 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1932425337 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207R00000X | Internal Medicine | MD 022285 (Louisiana) | Primary |
| Provider Name | Mary I Long |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1972500221 PECOS PAC ID: 4981735834 Enrollment ID: I20100622000279 |
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