Healthcare Provider Details

I. General information

NPI: 1982813192
Provider Name (Legal Business Name): MICHAEL JAMES SLOUP ATC
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/22/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

506 COMANCHE ST
COLUMBUS NE
68601-8228
US

IV. Provider business mailing address

506 COMANCHE ST
COLUMBUS NE
68601-8228
US

V. Phone/Fax

Practice location:
  • Phone: 402-610-4634
  • Fax: 402-562-3334
Mailing address:
  • Phone: 402-610-4634
  • Fax: 402-562-3334

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2255A2300X
TaxonomyAthletic Trainer
License Number213
License Number StateNE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: