Provider Demographics
NPI:1588693246
Name:LONG ENTERPRISES
Entity type:Organization
Organization Name:LONG ENTERPRISES
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:WILLIAM
Authorized Official - Middle Name:GILMER
Authorized Official - Last Name:LONG
Authorized Official - Suffix:III
Authorized Official - Credentials:
Authorized Official - Phone:958-580-7852
Mailing Address - Street 1:101 E TOM LANDRY ST
Mailing Address - Street 2:
Mailing Address - City:MISSION
Mailing Address - State:TX
Mailing Address - Zip Code:78572-4160
Mailing Address - Country:US
Mailing Address - Phone:956-580-7852
Mailing Address - Fax:956-580-4122
Practice Address - Street 1:101 E TOM LANDRY ST
Practice Address - Street 2:
Practice Address - City:MISSION
Practice Address - State:TX
Practice Address - Zip Code:78572-4160
Practice Address - Country:US
Practice Address - Phone:956-580-7852
Practice Address - Fax:956-580-4122
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-02
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies