MEDICARE: MARK S. VERLANIC 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

General Provider Information

NPI Number	:	1568591444
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MARK S. VERLANIC ATC

Provider Business Mailing Address
First Line	:	2533 BUFFALO HORN DR
Second Line	:
City	:	LAUREL
State	:	MT
Zip	:	59044-8319
Country	:	US
Telephone Number	:	406-628-7780
Fax Number	:

Provider Business Practice Location Address
First Line	:	2201 SAINT JOHNS AVE
Second Line	:
City	:	BILLINGS
State	:	MT
Zip	:	59102-4708
Country	:	US
Telephone Number	:	406-655-1400
Fax Number	:

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

Provider Enumeration Date	:	03/05/2007
Last Update Date	:	07/08/2007

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