MEDICARE: TROY UNIVERSITY

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	261QS1000X	Student Health Clinic/Center

General Provider Information

NPI Number	:	1861767410
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	TROY UNIVERSITY

Provider Business Mailing Address
First Line	:	PO BOX 819020
Second Line	:
City	:	DALLAS
State	:	TX
Zip	:	75381-9020
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	5000 VETERANS STATIUM DR
Second Line	:
City	:	TROY
State	:	AL
Zip	:	36082-0001
Country	:	US
Telephone Number	:	334-670-5731
Fax Number	:

Authorized Official
Title or Position	:	HEAD ATHLETIC TRAINER
Name	:	CHUCK ASH
Credential	:
Telephone Number	:	334-670-5731

Provider Enumeration Date	:	03/15/2012
Last Update Date	:	03/15/2012

Similar Medicare Providers

1750353082 — MRS. ELIZABETH MCKINLEY LONG CRNP
Practice Location Address:

TROY UNIVERSITY , HAMIL HALL STUDENT HEALTH CENTER
TROY, AL
36082-0001

Practice Phone: 334-670-3452
Practice Fax: 334-670-3853

1497776561 — MRS. JACQUE CHIRICO CRNP
Practice Location Address:

321 VETERANS MEMORIAL DRIVE , SUITE 125
TROY, AL
36082-0001

Practice Phone: 334-670-3452
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1891812723 — JOHN ANDERSON ATC, LAT
Practice Location Address:

3212 STADIUM TOWERS , VETERANS DRIVE - TROY UNIVERSITY
TROY, AL
36082-0001

Practice Phone: 334-670-3722
Practice Fax:

1891906129 — MRS. ALYSON GRAMLEY ATC
Practice Location Address:

3230 STADIUM TOWER , TROY UNIVERSITY ATHLETIC TRAINING
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Practice Fax: 334-670-3870

1154513984 — DIANA AVERY-MONTGOMERY ATC
Practice Location Address:

TROY UNIVERSITY , 3230 STADIUM TOWER
TROY, AL
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Practice Phone: 334-670-3723
Practice Fax:

1730315565 — LORI JANE RACKLEY ATC/LAT
Practice Location Address:

3230 STADIUM TOWER DR
TROY, AL
36082-0001

Practice Phone: 334-670-3720
Practice Fax:

1932477916 — WHITNEY MARIE BRACK A.T.C., L.A.T
Practice Location Address:

3230 STADIUM TOWERS
TROY, AL
36082-0001

Practice Phone: 334-670-3720
Practice Fax: 334-670-3870

Directions to “TROY UNIVERSITY ” Practice Location

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