MEDICARE: MR. EDDIE T. BENION JR. ATC

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
1	2255A2300X	Athletic Trainer	AT-002442	OH

General Provider Information

NPI Number	:	1306058847
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. EDDIE T. BENION JR. ATC

Provider Business Mailing Address
First Line	:	2000 PROSPECT AVENUE
Second Line	:
City	:	CLEVELAND
State	:	OH
Zip	:	44115
Country	:	US
Telephone Number	:	216-687-5287
Fax Number	:	216-687-9355

Provider Business Practice Location Address
First Line	:	2000 PROSPECT AVENUE
Second Line	:
City	:	CLEVELAND
State	:	OH
Zip	:	44115
Country	:	US
Telephone Number	:	216-687-5287
Fax Number	:	216-687-9355

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/04/2007
Last Update Date	:	07/08/2007

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