Mike Todd Diede, ATC

Primary specialty

Athletic TrainerTaxonomy code 2255A2300X

License

6743304-4810 Issued in UT

Practice address

2178 Bridger Dr
Springville, UT 84663-9469

Phone

(801) 422-2145

Fax

(406) 422-0555

NPI assigned

Feb 17, 2006

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

Electronic endpoints 1

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": "1140134400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1569801600000",
    "number": "1184699738",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1500 UNIVERSITY DR",
            "address_2": "PE 109",
            "city": "BILLINGS",
            "state": "MT",
            "postal_code": "591010245",
            "telephone_number": "406-657-2351",
            "fax_number": "406-657-2399"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2178 BRIDGER DR",
            "city": "SPRINGVILLE",
            "state": "UT",
            "postal_code": "846639469",
            "telephone_number": "801-422-2145",
            "fax_number": "406-422-0555"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "DIEDE",
        "first_name": "MIKE",
        "middle_name": "TODD",
        "name_prefix": "Dr.",
        "credential": "ATC",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2006-02-17",
        "last_updated": "2019-09-30",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "2255A2300X",
            "taxonomy_group": "",
            "desc": "Specialist/Technologist, Athletic Trainer",
            "state": "UT",
            "license": "6743304-4810",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "CONNECT",
            "endpointTypeDescription": "CONNECT URL",
            "endpoint": "Provo",
            "affiliation": "N",
            "endpointDescription": "BYU",
            "use": "DIRECT",
            "useDescription": "Direct",
            "contentType": "CSV",
            "contentTypeDescription": "CSV",
            "address_1": "2178 Bridger Dr",
            "city": "Springville",
            "state": "UT",
            "country_code": "US",
            "postal_code": "846639469",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

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• Athletic Trainer in Springville, UT
• Providers in Springville, UT by specialty
• Athletic Trainer in Utah

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 30, 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.