1619429271 NPI number — MR. CASEY DEAN CARLSON ATC

Table of content: MR. CASEY DEAN CARLSON ATC (NPI 1619429271)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1619429271 NPI number — MR. CASEY DEAN CARLSON ATC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
CARLSON
Provider First Name:
CASEY
Provider Middle Name:
DEAN
Provider Name Prefix Text:
MR.
Provider Name Suffix Text:
Provider Credential Text:
ATC
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1619429271
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
11/04/2016
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1800 COLLEGE AVE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
MANHATTAN
Provider Business Mailing Address State Name:
KS
Provider Business Mailing Address Postal Code:
66502-3308
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
785-532-7244
Provider Business Mailing Address Fax Number:
785-532-1776

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1800 COLLEGE AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
MANHATTAN
Provider Business Practice Location Address State Name:
KS
Provider Business Practice Location Address Postal Code:
66502-3308
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
785-532-7244
Provider Business Practice Location Address Fax Number:
785-532-1776
Provider Enumeration Date:
10/31/2016

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 2255A2300X , with the licence number:  2401142 , registered in the state of KS ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 2000010876 . This is a "BOARD OF CERTIFICATION" identifier . This identifiers is of the category "OTHER".
  • Identifier: AT002151 . This is a "GEORGIA BOARD OF ATHLETIC TRAINERS" identifier , issued by the state of ( GA ) . This identifiers is of the category "OTHER".
  • Identifier: 2401142 . This is a "KANSAS BOARD OF HEALING ARTS ATHLETIC" identifier , issued by the state of ( KS ) . This identifiers is of the category "OTHER".
  • Identifier: AT.0001391 . This is a "DEPARTMENT OF REGULATORY AGENCIES ATHLETIC TRAINING" identifier , issued by the state of ( CO ) . This identifiers is of the category "OTHER".




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