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NPI Code Detail

MEDICARE: MR. JAMES GLEN LANCASTER ATC, LAT

MEDICARE: MR. JAMES GLEN LANCASTER ATC, LAT
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 TrainerAT0560TX

General Provider Information

NPI Number : 1649300849
Entity Type Code : Individual
Provider Name (Legal Business Name) : MR. JAMES GLEN LANCASTER ATC, LAT
Provider Business Mailing Address
First Line : 1013 DIANA DR
Second Line :
City : EDINBURG
State : TX
Zip : 78542-5120
Country : US
Telephone Number : 956-381-8557
Fax Number :
Provider Business Practice Location Address
First Line : 1201 W UNIVERSITY DR
Second Line : DEPT. OF INTERCOLLEGIATE ATHLETICS
City : EDINBURG
State : TX
Zip : 78539-2909
Country : US
Telephone Number : 956-665-2233
Fax Number : 956-665-7200
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 03/06/2007
Last Update Date : 09/06/2015

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