Active NPI
Telisa Long
- Private Vehicle
- Park Forest, IL
National Provider Identifier
1285866111
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Private Vehicle
- License
- L52081680690
- Practice address
- 413 Indianwood Blvd
Park Forest, IL 60466-2247 - Phone
- (708) 369-2368
- Fax
- (708) 747-5980
- NPI assigned
- Aug 11, 2009
- Sex
- Female
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Private Vehicle | 347C00000X | L52081680690 | IL | Primary |
Addresses
Primary practice location
413 Indianwood Blvd
Park Forest, IL 60466-2247
Mailing address
413 Indianwood Blvd
Park Forest, IL 60466-2247
Phone (708) 369-2368
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| L52081680690 | IL | MD | Private Vehicle |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1249948800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1249948800000",
"number": "1285866111",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "413 INDIANWOOD BLVD",
"city": "PARK FOREST",
"state": "IL",
"postal_code": "604662247",
"telephone_number": "708-369-2368",
"fax_number": "708-747-5980"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "413 INDIANWOOD BLVD",
"city": "PARK FOREST",
"state": "IL",
"postal_code": "604662247",
"telephone_number": "708-369-2368",
"fax_number": "708-747-5980"
}
],
"practiceLocations": [],
"basic": {
"last_name": "LONG",
"first_name": "TELISA",
"name_prefix": "Ms.",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2009-08-11",
"last_updated": "2009-08-11",
"status": "A"
},
"taxonomies": [
{
"code": "347C00000X",
"taxonomy_group": "",
"desc": "Private Vehicle",
"state": "IL",
"license": "L52081680690",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Park Forest, IL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 11, 2009; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.