MEDICARE: MATTHEW BOWDEN 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	146D00000X	Personal Emergency Response Attendant	2016032815	MO
2	2255A2300X	Athletic Trainer	2016032815	MO

General Provider Information

NPI Number	:	1538607635
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MATTHEW BOWDEN ATC

Provider Business Mailing Address
First Line	:	8814 OAK CREEK DR
Second Line	:
City	:	SAINT LOUIS
State	:	MO
Zip	:	63126-2130
Country	:	US
Telephone Number	:	402-203-3457
Fax Number	:

Provider Business Practice Location Address
First Line	:	209 S KINGSHIGHWAY ST
Second Line	:
City	:	SAINT CHARLES
State	:	MO
Zip	:	63301-1695
Country	:	US
Telephone Number	:	636-949-4949
Fax Number	:

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

Provider Enumeration Date	:	02/08/2017
Last Update Date	:	09/04/2020

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