MEDICARE: MR. BOBBY RICHARD HELMICK II 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

General Provider Information

NPI Number	:	1942273321
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. BOBBY RICHARD HELMICK II ATC

Provider Business Mailing Address
First Line	:	4120 VENABLE AVE
Second Line	:
City	:	CHARLESTON
State	:	WV
Zip	:	25304-2414
Country	:	US
Telephone Number	:	304-925-1450
Fax Number	:

Provider Business Practice Location Address
First Line	:	2300 MACCORKLE AVE SE
Second Line	:
City	:	CHARLESTON
State	:	WV
Zip	:	25304-1045
Country	:	US
Telephone Number	:	304-357-4814
Fax Number	:	304-357-4989

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

Provider Enumeration Date	:	02/08/2006
Last Update Date	:	08/07/2007

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