Provider Demographics
NPI:1154878122
Name:LONG AND ASSOCIATES PAIN THERAPY INC
Entity type:Organization
Organization Name:LONG AND ASSOCIATES PAIN THERAPY INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:KIANA
Authorized Official - Middle Name:D
Authorized Official - Last Name:LONG
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:816-795-5300
Mailing Address - Street 1:19550 E 39TH ST S
Mailing Address - Street 2:SUITE 235
Mailing Address - City:INDEPENDENCE
Mailing Address - State:MO
Mailing Address - Zip Code:64057-2358
Mailing Address - Country:US
Mailing Address - Phone:816-795-5300
Mailing Address - Fax:816-795-5305
Practice Address - Street 1:19550 E 39TH ST S
Practice Address - Street 2:SUITE 235
Practice Address - City:INDEPENDENCE
Practice Address - State:MO
Practice Address - Zip Code:64057-2358
Practice Address - Country:US
Practice Address - Phone:816-795-5300
Practice Address - Fax:816-795-5305
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-09-07
Last Update Date:2016-09-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2010000750208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral PracticeGroup - Multi-Specialty