MEDICARE: MR. ANTHONY DAVID SILVA 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
1	2255A2300X	Athletic Trainer	0043	SD

General Provider Information

NPI Number	:	1912059197
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. ANTHONY DAVID SILVA ATC

Provider Business Mailing Address
First Line	:	1200 UNIVERSITY ST
Second Line	:	UNIT 9430
City	:	SPEARFISH
State	:	SD
Zip	:	57799-9430
Country	:	US
Telephone Number	:	605-642-6001
Fax Number	:	605-642-6539

Provider Business Practice Location Address
First Line	:	1200 UNIVERSITY ST
Second Line	:	UNIT 9430
City	:	SPEARFISH
State	:	SD
Zip	:	57799-9430
Country	:	US
Telephone Number	:	605-642-6001
Fax Number	:	605-642-6539

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

Provider Enumeration Date	:	01/17/2007
Last Update Date	:	07/08/2007

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