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NPI Code Detail

MEDICARE: MATTHEW VAIL AT

MEDICARE: MATTHEW VAIL AT
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
12255A2300XAthletic Trainer
22255A2300XAthletic TrainerND
32255A2300XAthletic Trainer855-19ND

General Provider Information

NPI Number : 1063996304
Entity Type Code : Individual
Provider Name (Legal Business Name) : MATTHEW VAIL AT
Provider Business Mailing Address
First Line : 234 14TH AVE SE APT 310
Second Line :
City : MINOT
State : ND
Zip : 58701-5983
Country : US
Telephone Number : 913-271-1739
Fax Number :
Provider Business Practice Location Address
First Line : 500 UNIVERSITY AVE W
Second Line :
City : MINOT
State : ND
Zip : 58707-0001
Country : US
Telephone Number : 913-271-1739
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 09/22/2018
Last Update Date : 07/17/2019

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Directions to “ MATTHEW VAIL AT” Practice Location

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