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NPI Code Detail

MEDICARE: MR. JOSHUA CHURCH

MEDICARE:  MR. JOSHUA  CHURCH
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 Trainer643NE

General Provider Information

NPI Number : 1457768061
Entity Type Code : Individual
Provider Name (Legal Business Name) : MR. JOSHUA CHURCH
Provider Business Mailing Address
First Line : 710 N TURNER AVE
Second Line :
City : HASTINGS
State : NE
Zip : 68901-7621
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 710 N TURNER AVE
Second Line :
City : HASTINGS
State : NE
Zip : 68901-7621
Country : US
Telephone Number : 402-705-3708
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 07/15/2014
Last Update Date : 07/15/2014

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Directions to “ MR. JOSHUA CHURCH ” Practice Location

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