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NPI Code Detail

MEDICARE: MR. JAMES BRENDAN MCHALE A.T.C.

MEDICARE: MR. JAMES BRENDAN MCHALE A.T.C.
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 TrainerIL

General Provider Information

NPI Number : 1881653376
Entity Type Code : Individual
Provider Name (Legal Business Name) : MR. JAMES BRENDAN MCHALE A.T.C.
Provider Business Mailing Address
First Line : 810 W ANTHONY DR
Second Line :
City : URBANA
State : IL
Zip : 61802-7431
Country : US
Telephone Number : 217-383-4105
Fax Number : 217-326-2368
Provider Business Practice Location Address
First Line : 810 W ANTHONY DR
Second Line :
City : URBANA
State : IL
Zip : 61802-7431
Country : US
Telephone Number : 217-383-4105
Fax Number : 217-326-2368
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 03/22/2006
Last Update Date : 07/08/2007

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