Healthcare Provider Details

I. General information

NPI: 1255497624
Provider Name (Legal Business Name): JASON MAURICE CATES ATC
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/29/2006
Last Update Date: 03/30/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

401 N LINCOLN ST
CABOT AR
72023-2625
US

IV. Provider business mailing address

28 EMERALD CIR
CABOT AR
72023-8176
US

V. Phone/Fax

Practice location:
  • Phone: 501-743-3541
  • Fax: 501-941-2438
Mailing address:
  • Phone: 501-920-2998
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2255A2300X
TaxonomyAthletic Trainer
License Number182
License Number StateAR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: