Healthcare Provider Details

I. General information

NPI: 1427024546
Provider Name (Legal Business Name): ARTHUR MARCUS MCGUFFIN III ATC
Entity Type: Individual
Gender: Male
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 02/28/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1018 TOWN DR
HIGHLAND HEIGHTS KY
41076-9138
US

IV. Provider business mailing address

1520 GREENUP ST
COVINGTON KY
41011-3441
US

V. Phone/Fax

Practice location:
  • Phone: 859-572-0710
  • Fax: 859-572-0716
Mailing address:
  • Phone: 859-240-7973
  • Fax: 859-292-0332

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2255A2300X
TaxonomyAthletic Trainer
License NumberAT028
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: