1619328366 NPI number — MR. ROBERT STEVEN LONG MS, ATC

Table of content: MR. ROBERT STEVEN LONG MS, ATC (NPI 1619328366)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1619328366 NPI number — MR. ROBERT STEVEN LONG MS, ATC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
LONG
Provider First Name:
ROBERT
Provider Middle Name:
STEVEN
Provider Name Prefix Text:
MR.
Provider Name Suffix Text:
Provider Credential Text:
MS, ATC
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1619328366
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
06/23/2016
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
6401 S HAZEL ST APT 110
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
PINE BLUFF
Provider Business Mailing Address State Name:
AR
Provider Business Mailing Address Postal Code:
71603-7842
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
662-897-4314
Provider Business Mailing Address Fax Number:
870-575-4655

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1200 UNIVERSITY DR
Provider Second Line Business Practice Location Address:
4891
Provider Business Practice Location Address City Name:
PINE BLUFF
Provider Business Practice Location Address State Name:
AR
Provider Business Practice Location Address Postal Code:
71601-2780
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
870-575-7230
Provider Business Practice Location Address Fax Number:
870-575-4655
Provider Enumeration Date:
06/23/2016

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 2255A2300X , with the licence number:  AT 672 , registered in the state of AR ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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