Active NPI
Michael R Gnacinski, ATC
- Athletic Trainer
- Edwards, CO
National Provider Identifier
1457628018
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Athletic Trainer
- License
- 783
- Practice address
- 1140 Edwards Village Building 105
Edwards, CO 81632 - Phone
- (970) 569-3240
- Fax
- (970) 569-3260
- NPI assigned
- Nov 28, 2011
- 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 | 783 | CO | Primary |
Addresses
Primary practice location
1140 Edwards Village Building 105
Edwards, CO 81632
Mailing address
PO Box 2743
1140 Edwards Village B-105
Edwards, CO 81632-2743
Phone (970) 569-3240
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 |
|---|---|---|---|
| 783 | CO | MD | Marriage & Family Therapist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1322438400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1322438400000",
"number": "1457628018",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "PO BOX 2743",
"address_2": "1140 EDWARDS VILLAGE B-105",
"city": "EDWARDS",
"state": "CO",
"postal_code": "816322743",
"telephone_number": "970-569-3240",
"fax_number": "970-659-3260"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1140 EDWARDS VILLAGE BUILDING 105",
"city": "EDWARDS",
"state": "CO",
"postal_code": "81632",
"telephone_number": "970-569-3240",
"fax_number": "970-569-3260"
}
],
"practiceLocations": [],
"basic": {
"last_name": "GNACINSKI",
"first_name": "MICHAEL",
"middle_name": "R",
"name_prefix": "Mr.",
"credential": "ATC",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2011-11-28",
"last_updated": "2011-11-28",
"status": "A"
},
"taxonomies": [
{
"code": "2255A2300X",
"taxonomy_group": "",
"desc": "Specialist/Technologist, Athletic Trainer",
"state": "CO",
"license": "783",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Edwards, CO
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 28, 2011; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.