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Clarissa Anne Long

Student in an Organized Health Care Education/Training Program

Student, Health Care

11937 Us Highway 271, Tyler, TX 75708-3154

PECOS Enrollment

This provider is enrolled in PECOS as CLARISSA LONG.

Based on the most recent information from CMS, provider Clarissa Anne Long is legally eligible to order and refer claims for Part B, HHA, DME and PMD services.

Part B
Medicare Part B
Enrolled
HHA
Home Health Agency
Enrolled
DME
Durable Medical Equipment
Enrolled
PMD
Power Mobility Device
Enrolled

CMS last updated its PECOS records 2 days ago.

Profile Details

Provider ID
1245922103
Provider Type
Individual
Full Name
Long, Clarissa Anne
Credential
DO

Gender
Female
Sole Proprietor
No
Enumeration Date
5/22/2023
Last Updated
5/22/2023

Contact Information

Practice Location

11937 Us Highway 271, Tyler, TX 75708-3154

(903) 877-7200

Unlisted Fax

Mailing Location

11937 Us Highway 271, Tyler, TX 75708-3154

(903) 877-7200

Unlisted Fax

Provider Taxonomies

Code	Description	License
Code 390200000X Primary	Description Student in an Organized Health Care Education/Training Program Student, Health Care	License Unlisted Issuer

Clarissa Anne Long

PECOS Enrollment

Profile Details

Contact Information

Practice Location

Mailing Location

Provider Taxonomies

Code

Description

License

Code

Description

License

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