MEDICARE: ATHLETIC TRAINING SOLUTIONS LLC

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

General Provider Information

NPI Number	:	1740568054
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ATHLETIC TRAINING SOLUTIONS LLC

Provider Business Mailing Address
First Line	:	P.O. BOX 637444
Second Line	:
City	:	CINCINNATI
State	:	OH
Zip	:	45263-7444
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	872 OHIO PIKE
Second Line	:
City	:	CINCINNATI
State	:	OH
Zip	:	45263-0000
Country	:	US
Telephone Number	:	513-999-9999
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	MR. MATTHEW W SMITH
Credential	:	ATC
Telephone Number	:	513-843-7632

Provider Enumeration Date	:	08/03/2011
Last Update Date	:	08/03/2011

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