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NPI Code Detail

MEDICARE: MR. MARK THOMAS SCHOENFELDER ATC

MEDICARE: MR. MARK THOMAS SCHOENFELDER 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 Trainer373NE

General Provider Information

NPI Number : 1699740803
Entity Type Code : Individual
Provider Name (Legal Business Name) : MR. MARK THOMAS SCHOENFELDER ATC
Provider Business Mailing Address
First Line : 912 HILLSIDE DR
Second Line :
City : WAYNE
State : NE
Zip : 68787-1562
Country : US
Telephone Number : 402-316-8266
Fax Number :
Provider Business Practice Location Address
First Line : 1111 MAIN ST
Second Line : WILDCAT SPORTS MEDICINE CENTER
City : WAYNE
State : NE
Zip : 68787-1181
Country : US
Telephone Number : 402-375-7582
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 02/21/2006
Last Update Date : 07/08/2007

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