Active NPI
Zane T Wildermuth, ATC
- Athletic Trainer
- Jackson Center, OH
National Provider Identifier
1447761044
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Athletic Trainer
- License
- 003902
- Practice address
- 1001 W Pike St
Jackson Center, OH 45334-6066 - Phone
- (937) 596-6111
- NPI assigned
- Oct 23, 2017
- Last updated
- Aug 22, 2022
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Athletic Trainer | 2255A2300X | 003902 | OH | Primary |
Addresses
Primary practice location
1001 W Pike St
Jackson Center, OH 45334-6066
Mailing address
1001 W Pike St
Jackson Center, OH 45334-6066
Phone (937) 596-6111
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 003902 | OH | MD | Athletic Trainer |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1508716800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1661126400000",
"number": "1447761044",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1001 W PIKE ST",
"city": "JACKSON CENTER",
"state": "OH",
"postal_code": "453346066",
"telephone_number": "937-596-6111"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1001 W PIKE ST",
"city": "JACKSON CENTER",
"state": "OH",
"postal_code": "453346066",
"telephone_number": "937-596-6111"
}
],
"practiceLocations": [],
"basic": {
"last_name": "WILDERMUTH",
"first_name": "ZANE",
"middle_name": "T",
"credential": "ATC",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2017-10-23",
"last_updated": "2022-08-22",
"certification_date": "2022-08-22",
"status": "A"
},
"taxonomies": [
{
"code": "2255A2300X",
"taxonomy_group": "",
"desc": "Specialist/Technologist, Athletic Trainer",
"state": "OH",
"license": "003902",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Jackson Center, OH
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 22, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.