MEDICARE: MR. DONALD CORNELL SIMS JR. MS, 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

General Provider Information

NPI Number	:	1851336606
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. DONALD CORNELL SIMS JR. MS, ATC

Provider Business Mailing Address
First Line	:	1015 E COZZA DR
Second Line	:	APT 71
City	:	SPOKANE
State	:	WA
Zip	:	99208-6642
Country	:	US
Telephone Number	:	509-359-4763
Fax Number	:

Provider Business Practice Location Address
First Line	:	207 PHYSICAL EDUCATION BUILDING
Second Line	:
City	:	CHENEY
State	:	WA
Zip	:	99004-2476
Country	:	US
Telephone Number	:	509-359-4763
Fax Number	:

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

Provider Enumeration Date	:	06/17/2006
Last Update Date	:	07/08/2007

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