MEDICARE: NATHANIEL MARKUS BARTELL LAT, 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	24-00451	KS

General Provider Information

NPI Number	:	1477764082
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	NATHANIEL MARKUS BARTELL LAT, ATC

Provider Business Mailing Address
First Line	:	115 W VESPER ST
Second Line	:
City	:	HESSTON
State	:	KS
Zip	:	67062-8927
Country	:	US
Telephone Number	:	620-327-2227
Fax Number	:

Provider Business Practice Location Address
First Line	:	800 MEDICAL CENTER DR
Second Line	:	SUITE 220
City	:	NEWTON
State	:	KS
Zip	:	67114-7808
Country	:	US
Telephone Number	:	316-283-6833
Fax Number	:

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

Provider Enumeration Date	:	05/24/2007
Last Update Date	:	10/07/2009

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