MEDICARE: MR. LAWRENCE W STARNES II 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	AT40	KY

General Provider Information

NPI Number	:	1356301063
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. LAWRENCE W STARNES II ATC

Provider Business Mailing Address
First Line	:	5618 BROWNSVILLE RD
Second Line	:
City	:	BROWNSVILLE
State	:	KY
Zip	:	42210-9412
Country	:	US
Telephone Number	:	270-597-3429
Fax Number	:	270-597-3429

Provider Business Practice Location Address
First Line	:	200 WILD CAT WAY
Second Line	:
City	:	BROWNSVILLE
State	:	KY
Zip	:	42210-9032
Country	:	US
Telephone Number	:	270-597-2151
Fax Number	:	270-597-2693

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

Provider Enumeration Date	:	03/25/2006
Last Update Date	:	07/08/2007

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