Provider Demographics
NPI:1992892632
Name:LONGS HOME MED SRVC AND EQUIP INC.
Entity type:Organization
Organization Name:LONGS HOME MED SRVC AND EQUIP INC.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MRS
Authorized Official - First Name:DOTTIE
Authorized Official - Middle Name:
Authorized Official - Last Name:CULLEN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:352-735-1120
Mailing Address - Street 1:3801 N HIGHWAY 19A
Mailing Address - Street 2:STE 408
Mailing Address - City:MOUNT DORA
Mailing Address - State:FL
Mailing Address - Zip Code:32757-2228
Mailing Address - Country:US
Mailing Address - Phone:352-735-1120
Mailing Address - Fax:352-735-1137
Practice Address - Street 1:3801 N HIGHWAY 19A
Practice Address - Street 2:STE 408
Practice Address - City:MOUNT DORA
Practice Address - State:FL
Practice Address - Zip Code:32757-2228
Practice Address - Country:US
Practice Address - Phone:352-735-1120
Practice Address - Fax:352-735-1137
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-06
Last Update Date:2011-06-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL1312180332BX2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332BX2000XSuppliersDurable Medical Equipment & Medical SuppliesOxygen Equipment & Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL026896800Medicaid
FLR5491OtherBCBS FEDERAL PROVIEDER ID
FL026896800Medicaid