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NPI Code Detail

MEDICARE: LOGAN ECK ATC, LAT

MEDICARE: LOGAN ECK ATC, LAT
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
12255A2300XAthletic Trainer2014028474MO

General Provider Information

NPI Number : 1235539586
Entity Type Code : Individual
Provider Name (Legal Business Name) : LOGAN ECK ATC, LAT
Provider Business Mailing Address
First Line : 4525 DOWNS DR
Second Line :
City : SAINT JOSEPH
State : MO
Zip : 64507-2246
Country : US
Telephone Number : 816-271-4597
Fax Number :
Provider Business Practice Location Address
First Line : 4525 DOWNS DR
Second Line :
City : SAINT JOSEPH
State : MO
Zip : 64507-2246
Country : US
Telephone Number : 816-271-4597
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 08/23/2014
Last Update Date : 08/23/2014

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Directions to “ LOGAN ECK ATC, LAT” Practice Location

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