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NPI Code Detail

MEDICARE: MR. EDWARD JOSEPH STRECKFUS IV ATC

MEDICARE: MR. EDWARD JOSEPH STRECKFUS IV 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
12255A2300XAthletic Trainer24-01061KS

General Provider Information

NPI Number : 1881059095
Entity Type Code : Individual
Provider Name (Legal Business Name) : MR. EDWARD JOSEPH STRECKFUS IV ATC
Provider Business Mailing Address
First Line : 125 W COOPER ST
Second Line :
City : STERLING
State : KS
Zip : 67579-1533
Country : US
Telephone Number : 620-278-4338
Fax Number :
Provider Business Practice Location Address
First Line : 125 W COOPER ST
Second Line :
City : STERLING
State : KS
Zip : 67579-1533
Country : US
Telephone Number : 620-278-4338
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 12/15/2015
Last Update Date : 12/15/2015

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