MEDICARE: JOSEPH KAPIGENO URBIN

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	1241311704

General Provider Information

NPI Number	:	1720888167
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JOSEPH KAPIGENO URBIN

Provider Business Mailing Address
First Line	:	10726 LONNIE LN
Second Line	:
City	:	COLLEGE DALE
State	:	TN
Zip	:	37363-8522
Country	:	US
Telephone Number	:	509-655-5417
Fax Number	:

Provider Business Practice Location Address
First Line	:	9408 APISON PIKE STE 174
Second Line	:
City	:	COLLEGE DALE
State	:	TN
Zip	:	37363-5977
Country	:	US
Telephone Number	:	423-702-8463
Fax Number	:

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

Provider Enumeration Date	:	03/14/2025
Last Update Date	:	03/14/2025

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