| Dr Kenneth Michael Long, DO | |
|
5907 Highway 90, Moss Point, MS 39563-6536 | |
| (228) 769-2611 | |
| Not Available |
| Full Name | Dr Kenneth Michael Long |
|---|---|
| Gender | Male |
| Speciality | Family Medicine |
| Location | 5907 Highway 90, Moss Point, Mississippi |
| Accepts Medicare Assignments | Medicare enrolled and may accept medicare through third-party reassignment. May prescribe medicare part D drugs. |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1346535390 | NPI | - | NPPES |
| P01332510 | Other | MS | RAILROAD MEDICARE |
| 08224277 | Medicaid | MS |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207Q00000X | Family Medicine | 311654 (Louisiana) | Secondary |
| 207Q00000X | Family Medicine | 22826 (Mississippi) | Primary |
| Entity Name | Mississippi Providence Healthcare Services, Inc. |
|---|---|
| Entity Type | Part B Supplier - Clinic/group Practice |
| Entity Identifiers | NPI Number: 1821340407 PECOS PAC ID: 8729239371 Enrollment ID: O20121108000396 |
| Mailing Address | Practice Location Address |
|---|---|
| Dr Kenneth Michael Long, DO 5907 Highway 90, Moss Point, MS 39563-6536 Ph: (504) 842-4000 | Dr Kenneth Michael Long, DO 5907 Highway 90, Moss Point, MS 39563-6536 Ph: (228) 769-2611 |
Dr. Paul S. Fineburg, M.D. Family Medicine Medicare: Accepting Medicare Assignments Practice Location: 5907 Highway 90, Moss Point, MS 39563 Phone: 228-769-2611 Fax: 228-762-1638 | |
Dunk A. Ellis Iii, MD Family Medicine Medicare: Accepting Medicare Assignments Practice Location: 3736 Main St, Moss Point, MS 39563 Phone: 228-474-2212 Fax: 228-475-6271 | |
Brock Nathaniel Banks, M.D. Family Medicine Medicare: Accepting Medicare Assignments Practice Location: 5907 Highway 90, Moss Point, MS 39563 Phone: 228-769-2611 | |
Dr. Matthew Wayne Murray, M.D. Family Medicine Medicare: Accepting Medicare Assignments Practice Location: 5907 Highway 90, Moss Point, MS 39563 Phone: 228-769-2611 Fax: 228-934-2481 | |
Dr. Calvin S Ennis, M.D. Family Medicine Medicare: Not Enrolled in Medicare Practice Location: 8006 Hwy 613, Moss Point, MS 39562 Phone: 228-475-1166 Fax: 228-475-9337 | |
Dr. Richard S. Whitlock, M.D. Family Medicine Medicare: Accepting Medicare Assignments Practice Location: 5907 Highway 90, Moss Point, MS 39563 Phone: 228-769-2611 Fax: 228-762-1638 |