MEDICARE: MR. SAMUEL BUSCHER 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	AT001402	WV

General Provider Information

NPI Number	:	1679010490
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. SAMUEL BUSCHER ATC

Provider Business Mailing Address
First Line	:	109 LAUREL ST
Second Line	:
City	:	HARRISONBURG
State	:	VA
Zip	:	22801-2762
Country	:	US
Telephone Number	:	815-931-3311
Fax Number	:

Provider Business Practice Location Address
First Line	:	402 E COLLEGE ST
Second Line	:
City	:	BRIDGEWATER
State	:	VA
Zip	:	22812-1511
Country	:	US
Telephone Number	:	815-931-3311
Fax Number	:

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

Provider Enumeration Date	:	01/31/2017
Last Update Date	:	07/23/2020

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