Blaine Long, ATC

Primary specialty

Athletic TrainerTaxonomy code 2255A2300X

License

2601001208 Issued in MI

Practice address

1203 Health Professions Building
Central Michigan University
Mount Pleasant, MI 48859-9339

Phone

(989) 774-2805

Fax

(989) 774-3024

NPI assigned

Jan 18, 2016

Last updated

Feb 3, 2016By the provider in NPPES

Sex

Male

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1453075200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1454457600000",
    "number": "1871950113",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1203 HEALTH PROFESSIONS BUILDING",
            "address_2": "CENTRAL MICHIGAN UNIVERSITY",
            "city": "MOUNT PLEASANT",
            "state": "MI",
            "postal_code": "488599339",
            "telephone_number": "989-774-2805",
            "fax_number": "989-774-3024"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1203 HEALTH PROFESSIONS BUILDING",
            "address_2": "CENTRAL MICHIGAN UNIVERSITY",
            "city": "MOUNT PLEASANT",
            "state": "MI",
            "postal_code": "488599339",
            "telephone_number": "989-774-2805",
            "fax_number": "989-774-3024"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "LONG",
        "first_name": "BLAINE",
        "name_prefix": "Dr.",
        "credential": "ATC",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2016-01-18",
        "last_updated": "2016-02-03",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "2255A2300X",
            "taxonomy_group": "",
            "desc": "Specialist/Technologist, Athletic Trainer",
            "state": "MI",
            "license": "2601001208",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Lo Optical, LLC (LO Optical)
• Brian Howard Locke, DPT, AT, ATC
• Jaelin M Lockwood
• Hannah Logan, LPN
• Jill Lohman
• Edgar Charles John Long, PH.D.
• John Joseph Longmore Jr., PTA
• Jordyn E Loomis, PTA
• John Edward Lopes Jr., PA-C
• Amanda Lee Lopez, PH.D

• Athletic Trainer in Mt Pleasant, MI
• Providers in Mt Pleasant, MI by specialty
• Athletic Trainer in Michigan

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 3, 2016; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.