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NPI Code Detail

MEDICARE: TRACYE N MENGES MS, ATC

MEDICARE: TRACYE N MENGES MS, 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
12255A2300XAthletic TrainerAT001337OH

General Provider Information

NPI Number : 1508078486
Entity Type Code : Individual
Provider Name (Legal Business Name) : TRACYE N MENGES MS, ATC
Provider Business Mailing Address
First Line : 1233 W 8TH ST
Second Line :
City : LORAIN
State : OH
Zip : 44052-1561
Country : US
Telephone Number : 440-204-1136
Fax Number :
Provider Business Practice Location Address
First Line : 5800 COOPER FOSTER PARK RD W
Second Line :
City : LORAIN
State : OH
Zip : 44053-4131
Country : US
Telephone Number : 440-204-7800
Fax Number : 440-204-7855
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 05/04/2007
Last Update Date : 07/08/2007

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