MEDICARE: LUKE J KOESTER AT

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	146N00000X	Basic Emergency Medical Technician	0155886	OH
2	2255A2300X	Athletic Trainer	AT004020	OH

General Provider Information

NPI Number	:	1902343163
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LUKE J KOESTER AT

Provider Business Mailing Address
First Line	:	6955 HOSPITAL DR
Second Line	:
City	:	DUBLIN
State	:	OH
Zip	:	43016-8580
Country	:	US
Telephone Number	:	614-533-3761
Fax Number	:

Provider Business Practice Location Address
First Line	:	1001 DEMOREST RD
Second Line	:
City	:	COLUMBUS
State	:	OH
Zip	:	43204-1043
Country	:	US
Telephone Number	:	614-801-3200
Fax Number	:

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

Provider Enumeration Date	:	01/26/2017
Last Update Date	:	01/26/2017

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