Basic Information
| Provider Information | |||||||||
| NPI: | 1841266608 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | LONGO | ||||||||
| FirstName: | CHARLES | ||||||||
| MiddleName: | A | ||||||||
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| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2400 S MINNESOTA AVE | ||||||||
| Address2: | STE 100 | ||||||||
| City: | SIOUX FALLS | ||||||||
| State: | SD | ||||||||
| PostalCode: | 571053762 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6053227510 | ||||||||
| FaxNumber: | 6053226475 | ||||||||
| Practice Location | |||||||||
| Address1: | 1315 S. CLIFF AVE | ||||||||
| Address2: | STE 3000 | ||||||||
| City: | SIOUX FALLS | ||||||||
| State: | SD | ||||||||
| PostalCode: | 571051061 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6053227600 | ||||||||
| FaxNumber: | 6053227601 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 02/23/2006 | ||||||||
| LastUpdateDate: | 12/13/2013 | ||||||||
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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 | 207RE0101X | 5192 | SD | Y | Allopathic & Osteopathic Physicians | Internal Medicine | Endocrinology, Diabetes & Metabolism |
ID Information
| ID | Type | State | Issuer | Description | 1909119 | 01 | SD | ARAZ/ AMERICA'S PPO | OTHER | 240862 | 01 | SD | MIDLANDS CHOICE | OTHER | 46022474351 | 05 | NE | MEDICAID | 0574087 | 05 | IA | MEDICAID | 20762 | 01 | IA | BLUE CROSS | OTHER | 4995936 | 01 | SD | BLUE CROSS | OTHER | 5192 | 01 | SD | DAKOTACARE | OTHER | 028917500 | 05 | MN | MEDICAID | 6004720 | 05 | SD | MEDICAID | 57105Y004 | 01 | SD | WPS TRICARE | OTHER | HP40616 | 01 | SD | HEALTHPARTNERS | OTHER | 34596 | 01 | SD | SANFORD HEALTH PLAN | OTHER | P00095104 | 01 | SD | RR MEDICARE | OTHER | 157L6LO | 01 | MN | CC SYSTEMS/ BLUE PLUS | OTHER | 157L6LO | 01 | MN | BLUE CROSS | OTHER | 309991034635 | 01 | SD | PREFERRED ONE | OTHER | 3300147 | 01 | SD | MEDICA | OTHER |