BRENTON VAUGHN LONG


Address: 21159 Paint Blvd, Suite 2, Shippenville, PA 16254-4023
Phone: 8142266770

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).

Provider Overview

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

Taxonomy

Primary Taxonomy Code Classification License Number License State Taxonomy Group
Y 208D00000X General Practice OS004611L PA Allopathic & Osteopathic Physicians

Other Provider Identifier

State Issuer Identifier Type Code
PA 0008050560007 05

Office Location

Street Address 21159 PAINT BLVD
SUITE 2
City SHIPPENVILLE
State PA
Zip Code 16254-4023

Providers in the same location

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

Providers in the same zip code

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
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Taxonomy Information

Taxonomy Code 208D00000X
Grouping Allopathic & Osteopathic Physicians
Classification General Practice

Taxonomy Definition

Definition to come...

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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
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Competitor

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City SHIPPENVILLE
Zip Code 16254

Improve Information

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Dataset Information

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.

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