MEDICARE: MR. ARTHUR MARCUS MCGUFFIN III ATC

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
1	2255A2300X	Athletic Trainer	AT028	KY

General Provider Information

NPI Number	:	1427024546
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. ARTHUR MARCUS MCGUFFIN III ATC

Provider Business Mailing Address
First Line	:	1520 GREENUP ST
Second Line	:
City	:	COVINGTON
State	:	KY
Zip	:	41011-3441
Country	:	US
Telephone Number	:	859-240-7973
Fax Number	:	859-292-0332

Provider Business Practice Location Address
First Line	:	1018 TOWN DR
Second Line	:
City	:	HIGHLAND HEIGHTS
State	:	KY
Zip	:	41076-9138
Country	:	US
Telephone Number	:	859-572-0710
Fax Number	:	859-572-0716

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	02/28/2006
Last Update Date	:	07/08/2007

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