Active NPI
Robert Theodore Longshore, MD
- Family Medicine Physician
- Warsaw, KY
National Provider Identifier
1730101759
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Family Medicine Physician
- License
- 12488
- Practice address
- 870 US Hwy 42 W
Warsaw, KY 41095-9323 - Phone
- (859) 567-1591
- Fax
- (859) 567-1592
- NPI assigned
- Jul 25, 2006
- Sex
- Male
- Sole proprietor
- No
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 |
|---|---|---|---|---|
| Family Medicine Physician | 207Q00000X | 12488 | KY | Primary |
Addresses
Primary practice location
870 US Hwy 42 W
Warsaw, KY 41095-9323
Mailing address
2546 Kearney Court
Lakeside Park, KY 41017-2180
Phone (859) 344-8116
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 64124886 | Medicaid | KY |
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)
- Enrolled
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 12488 | KY | MD | Family Medicine Physician |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1153785600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1183852800000",
"number": "1730101759",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "2546 KEARNEY COURT",
"city": "LAKESIDE PARK",
"state": "KY",
"postal_code": "410172180",
"telephone_number": "859-344-8116"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "870 US HWY 42 W",
"city": "WARSAW",
"state": "KY",
"postal_code": "410959323",
"telephone_number": "859-567-1591",
"fax_number": "859-567-1592"
}
],
"practiceLocations": [],
"basic": {
"last_name": "LONGSHORE",
"first_name": "ROBERT",
"middle_name": "THEODORE",
"credential": "MD",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2006-07-25",
"last_updated": "2007-07-08",
"status": "A"
},
"taxonomies": [
{
"code": "207Q00000X",
"taxonomy_group": "",
"desc": "Family Medicine",
"state": "KY",
"license": "12488",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "64124886",
"state": "KY"
}
],
"endpoints": [],
"other_names": []
}Other providers in Warsaw, KY
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.