Scott James Belham, ATC, OPA-C

Individual provider Active NPI Athletic Trainer · Gulfport, MS

NPI 1477531259 · NPPES record last updated Feb 1, 2014

Key facts

NPI
1477531259
Entity type
Individual (NPI type 1)
Primary specialty
Athletic Trainer 2255A2300X
License
AT0051 (MS)
Practice address
12356 Windance Dr
Gulfport, MS 39503-7778
Phone
(228) 547-0318
Fax
(228) 831-0318
NPI assigned
Jan 3, 2006
Sex
Male
Sole proprietor
No

Medicare participation

Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file

National Provider Directory

Medicare enrollment (NPD)
No

State licenses

LicenseStateTypeSpecialty
AT0051MSMDAthletic Trainer

Specialties & licenses

Specialty (taxonomy)CodeLicenseStatePrimary
Athletic Trainer 2255A2300X AT0051 MS Yes

Addresses

Primary practice location

12356 Windance Dr
Gulfport, MS 39503-7778

Mailing address

12356 Windance Dr
Gulfport, MS 39503-7778
Phone (228) 547-0318

Other providers in Gulfport, MS

All providers in Gulfport, MS · Athletic Trainer in Mississippi

Sources for this page

Verify at the official NPI Registry.