Basic Information
| Provider Information | |||||||||
| NPI: | 1255309548 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | LONG | ||||||||
| FirstName: | JAMES | ||||||||
| MiddleName: | W | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 11230 | ||||||||
| Address2: | |||||||||
| City: | FORT SMITH | ||||||||
| State: | AR | ||||||||
| PostalCode: | 729171230 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4797096700 | ||||||||
| FaxNumber: | 4797096751 | ||||||||
| Practice Location | |||||||||
| Address1: | 3501 WE KNIGHT DR | ||||||||
| Address2: | |||||||||
| City: | FORT SMITH | ||||||||
| State: | AR | ||||||||
| PostalCode: | 729037994 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4797096700 | ||||||||
| FaxNumber: | 4797096751 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 03/10/2006 | ||||||||
| LastUpdateDate: | 12/14/2009 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207X00000X | R2078 | AR | Y | Allopathic & Osteopathic Physicians | Orthopaedic Surgery |
ID Information
| ID | Type | State | Issuer | Description | 1372578 | 01 | AR | CIGNA | OTHER | 100083360A | 01 | OK | OKLAHOMA MEDICAID | OTHER | 4613325 | 01 | AR | AETNA | OTHER | 15472000000 | 01 | AR | QUALCHOICE | OTHER | 920001 | 01 | AR | UNITED HEALTHCARE | OTHER | 200038805 | 01 | AR | RAILROAD MEDICARE | OTHER | 53200 | 01 | AR | ARKANSAS BLUE CROSS | OTHER | 105614001 | 05 | AR | MEDICAID | 904208 | 01 | AR | USA MCO | OTHER |