Provider Demographics
NPI:1366735110
Name:LONGSTROTH, BEN SCOTT (RN)
Entity type:Individual
Prefix:MR
First Name:BEN
Middle Name:SCOTT
Last Name:LONGSTROTH
Suffix:
Gender:M
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5303 E TRUMAN RD
Mailing Address - Street 2:#201
Mailing Address - City:KANSAS CITY
Mailing Address - State:MO
Mailing Address - Zip Code:64127-2888
Mailing Address - Country:US
Mailing Address - Phone:816-457-2572
Mailing Address - Fax:
Practice Address - Street 1:5303 E TRUMAN RD
Practice Address - Street 2:#201
Practice Address - City:KANSAS CITY
Practice Address - State:MO
Practice Address - Zip Code:64127-2888
Practice Address - Country:US
Practice Address - Phone:816-457-2572
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-05-25
Last Update Date:2011-05-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2011003614163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse