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General NPI Number Information
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NPI Number | 1598902546
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Entity Type | Individual
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Provider Name | EDWIN J CHAMPAGNE MED, ATC, LAT
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Gender | Male
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Dates
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Enumeration Date | 01/13/2009
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Last Update Date | 11/26/2015
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Provider Practice Location Address
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Address Line | 7173 FM 1628
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City | SAN ANTONIO
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State | TX
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Zip | 78263-9671
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Country | US
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Telephone | 210-581-1181
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Fax | 210-581-1357
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Provider Business Mailing Address
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Address Line | 7173 FM 1628
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City | SAN ANTONIO
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State | TX
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Zip | 78263-9671
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Country | US
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Telephone | 210-649-2951
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Fax | 210-581-1357
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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 | AT2538
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License Number State | TX
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