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General NPI Number Information
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NPI Number | 1053680272
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Entity Type | Organization
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Legal Business Name | CENTRAL METHODIST UNIVERISTY
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Dates
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Enumeration Date | 12/16/2011
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Last Update Date | 12/16/2011
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Provider Practice Location Address
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Address Line | 411 CENTRAL METHODIST SQ
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City | FAYETTE
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State | MO
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Zip | 65248-1104
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Country | US
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Telephone | 308-631-5364
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Fax |
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Provider Business Mailing Address
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Address Line | 180246 HIGHWAY 71
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City | GERING
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State | NE
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Zip | 69341-7526
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | ATHLETIC TRAINER
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Name | MR. THOMAS M BUEHLER
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Credential | ATC
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Telephone | 308-631-5364
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QR0400X
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Taxonomy Name | Rehabilitation Clinic/Center
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License Number | 2011025406
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License Number State | MO
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