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General NPI Number Information
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NPI Number | 1497973549
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Entity Type | Individual
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Provider Name | JASON MATTHEW CARL MA, ATC, CSCS
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Gender | Male
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Dates
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Enumeration Date | 04/23/2007
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Last Update Date | 06/03/2009
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Provider Practice Location Address
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Address Line | 900 HOSPITAL DR
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City | MADISONVILLE
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State | KY
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Zip | 42431-1653
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Country | US
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Telephone | 270-824-2000
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Fax | 270-821-8761
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Provider Business Mailing Address
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Address Line | 849 CHICKASAW DR
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City | MADISONVILLE
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State | KY
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Zip | 42431-8631
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Country | US
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Telephone | 270-339-3670
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2255A2300X
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Taxonomy Name | Athletic Trainer
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License Number | AT332
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License Number State | KY
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