BRENTON VAUGHN LONG (NPI# 1790751154) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
Nation Provider ID (NPI) | 1790751154 |
Entity Type | Individual |
Full Name | BRENTON VAUGHN LONG |
Credential | D.O. |
Practice Address |
21159 Paint Blvd Suite 2 Shippenville PA 16254-4023 |
Mailing Address |
121 Doctors Ln Clarion PA 16214-8515 |
Practice Telephone | 8142266770 |
Practice Fax Number | 8142261015 |
Mailing Telephone | 8142263470 |
Mailing Fax Number | 8142263479 |
Enumeration Date | 2006-02-27 |
Last Update Date | 2008-05-29 |
Gender Code | M |
Is Sole Proprietor | N |
Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
---|---|---|---|---|---|
Y | 208D00000X | General Practice | OS004611L | PA | Allopathic & Osteopathic Physicians |
State | Issuer | Identifier | Type Code |
---|---|---|---|
PA | 0008050560007 | 05 |
Street Address |
21159 PAINT BLVD SUITE 2 |
City | SHIPPENVILLE |
State | PA |
Zip Code | 16254-4023 |
NPI | Name | Taxonomy | Address | Enumeration |
---|---|---|---|---|
1518932334 | Janice Marie Kenneson | Family Medicine | 21159 Paint Blvd, Suite 2, Shippenville, PA 16254-4023 | 2006-02-23 |
1396180089 | Health Services of Clarion Inc | Non-Pharmacy Dispensing Site | 21159 Paint Blvd, Suite 2, Shippenville, PA 16254-4023 | 2013-05-08 |
1689983520 | Ashley Nicole Kunselman | Family Medicine | 21159 Paint Blvd, Suite 2, Shippenville, PA 16254-4023 | 2010-09-27 |
1649593500 | Nicole Carroll | Family Medicine | 21159 Paint Blvd, Suite 2, Shippenville, PA 16254-4023 | 2010-03-08 |
1033178793 | Health Services of Clarion, Inc. | Family Medicine | 21159 Paint Blvd, Suite 2, Shippenville, PA 16254-4023 | 2006-03-21 |
1255302071 | Clarion Development Corporation | Pharmacy | 21159 Paint Blvd, Suite #1, Shippenville, PA 16254 | 2006-01-30 |
NPI | Name | Taxonomy | Address | Enumeration |
---|---|---|---|---|
1659393155 | Brenda Arlene Manno | Social Worker | 20231 Paint Boulevard, Shippenville, PA 16254 | 2006-07-24 |
1275778417 | Shippenville Project Point of Light, Inc Dba Manno Therapeutic Service | Counselor | 20231 Paint Boulevard, Shippenville, PA 16254 | 2008-12-02 |
1821160268 | Vna Extended Care Services, Inc | Home Health | 405 Main Street, Shippenville, PA 16254 | 2006-11-14 |
1376536011 | Vna Extended Care Services, Inc | Home Health | 405 Main Street, Shippenville, PA 16254-0100 | 2005-08-29 |
1497741466 | Shippenville Elk Township Volunt | Ambulance | 207 Main St, Shippenville, PA 16254-3905 | 2005-09-23 |
1891339156 | Advanced Dysphagia Diagnostics LLC | Speech-Language Pathologist | 206 Main St, Shippenville, PA 16254-3906 | 2019-10-30 |
1467403782 | Ggnsc Shippenville Lp | Skilled Nursing Facility | 21158 Paint Blvd, Shippenville, PA 16254-4024 | 2006-05-12 |
1134672900 | Guardian Elder Care At Shippenville LLC | Skilled Nursing Facility | 21158 Paint Blvd, Shippenville, PA 16254-4024 | 2016-07-28 |
1396147765 | Jennifer Pappas | Physical Therapist | 21158 Paint Blvd, Shippenville, PA 16254-4024 | 2014-09-17 |
1679915201 | Melissa Sue Pore | Speech-Language Pathologist | 21158 Paint Blvd, Shippenville, PA 16254-4024 | 2013-07-24 |
Find all providers in zip 16254 |
Taxonomy Code | 208D00000X |
Grouping | Allopathic & Osteopathic Physicians |
Classification | General Practice |
Definition to come... |
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1831755735 | Good Hope Health Center Corp | General Practice | 7712 Buist Ave, Philadelphia, PA 19153-1705 | 2019-05-15 |
1366008260 | Ltc Treatment Center Inc | General Practice | 7712 Buist Ave Apt B, Philadelphia, PA 19153-1705 | 2019-05-15 |
1003479825 | Marsha Frances Santangelo | General Practice | 107 Sawgrass Drive, Blue Bell, PA 19422 | 2019-04-17 |
1972072288 | Paula Alejandra Pino Pommer | General Practice | 3551 North Broad St., Philadelphia, PA 19140-4160 | 2018-11-15 |
1033686159 | Star Wellness Center, Inc | General Practice | 511 E 3rd St Ste 202, Bethlehem, PA 18015-2180 | 2018-10-26 |
1891277620 | Donald C. Cameron | General Practice | 718 Kennett Pike, Chadds Ford, PA 19317 | 2018-08-29 |
1124510888 | Healing Place Medical, P.C. | General Practice | 1600 Horizon Dr Ste 122123, Chalfont, PA 18914-4100 | 2018-05-30 |
Find all providers with the same taxonomy |
City | SHIPPENVILLE |
Zip Code | 16254 |
Please comment or provide details below to improve the information on BRENTON VAUGHN LONG.
Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.