Paul Andrew Mahoney II, A.T.,C. L.A.T.

Primary specialty

Athletic TrainerTaxonomy code 2255A2300X

License

2601000611 Issued in MI

Practice address

6319 County Line Rd
Ira, MI 48023-1003

Phone

(586) 648-2528

NPI assigned

Jan 4, 2019

Sex

Male

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Other identifiers 2

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1546560000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1546560000000",
    "number": "1144793936",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "36668 CATALPA LN",
            "city": "NEW BALTIMORE",
            "state": "MI",
            "postal_code": "480475578",
            "telephone_number": "586-612-5120"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "6319 COUNTY LINE RD",
            "city": "IRA",
            "state": "MI",
            "postal_code": "480231003",
            "telephone_number": "586-648-2528"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MAHONEY",
        "first_name": "PAUL",
        "middle_name": "ANDREW",
        "name_suffix": "II",
        "credential": "A.T.,C.  L.A.T.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2019-01-04",
        "last_updated": "2019-01-04",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "2255A2300X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Specialist/Technologist, Athletic Trainer",
            "state": "MI",
            "license": "2601000611",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "STATE OF MICHIGAN  DEPARTMENT OF COMMUNITY HEALTH",
            "identifier": "2601000611",
            "state": "MI"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BOARD OF CERTIFICATION INC. (BOC)",
            "identifier": "049302490",
            "state": null
        }
    ],
    "endpoints": [],
    "other_names": []
}

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• Athletic Trainer in Ira, MI
• Providers in Ira, MI by specialty
• Athletic Trainer in Michigan

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 4, 2019; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.