Provider Demographics
NPI:1689891285
Name:NATIONAL ATHLETIC TRAINERS ASSOCIATION
Entity Type:Organization
Organization Name:NATIONAL ATHLETIC TRAINERS ASSOCIATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:LICENSED ATHLETIC TRAINER
Authorized Official - Prefix:MR
Authorized Official - First Name:TODD
Authorized Official - Middle Name:CAMERON
Authorized Official - Last Name:KIEFER
Authorized Official - Suffix:
Authorized Official - Credentials:LAT
Authorized Official - Phone:972-617-2075
Mailing Address - Street 1:1341 E HIGHLAND RD
Mailing Address - Street 2:
Mailing Address - City:WAXAHACHIE
Mailing Address - State:TX
Mailing Address - Zip Code:75167-7203
Mailing Address - Country:US
Mailing Address - Phone:972-617-2075
Mailing Address - Fax:
Practice Address - Street 1:154 LOUISE RITTER BLVD
Practice Address - Street 2:
Practice Address - City:RED OAK
Practice Address - State:TX
Practice Address - Zip Code:75154
Practice Address - Country:US
Practice Address - Phone:469-437-2183
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-18
Last Update Date:2008-06-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXAT1418302R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes302R00000XManaged Care OrganizationsHealth Maintenance Organization