Provider Demographics
NPI:1104693100
Name:LONGIE, THOMAS SCOTT JR
Entity type:Individual
Prefix:
First Name:THOMAS
Middle Name:SCOTT
Last Name:LONGIE
Suffix:JR
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:215 E ARBOR AVE APT 206A
Mailing Address - Street 2:
Mailing Address - City:BISMARCK
Mailing Address - State:ND
Mailing Address - Zip Code:58504-5700
Mailing Address - Country:US
Mailing Address - Phone:701-595-2819
Mailing Address - Fax:
Practice Address - Street 1:215 E ARBOR AVE APT 206A
Practice Address - Street 2:
Practice Address - City:BISMARCK
Practice Address - State:ND
Practice Address - Zip Code:58504-5700
Practice Address - Country:US
Practice Address - Phone:701-595-2819
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-12-08
Last Update Date:2023-12-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant