Samuel Hodges
Individual provider Active NPI Athletic Trainer · Mount Carmel, IL
NPI 1487063723 · NPPES record last updated Aug 12, 2014
Key facts
- NPI
- 1487063723
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Athletic Trainer 2255A2300X
- License
- 096003541 (IL)
- Practice address
- 1418 College Dr
Mount Carmel, IL 62863-2638 - Phone
- (618) 317-5256
- NPI assigned
- Aug 12, 2014
- Sex
- Male
- Sole proprietor
- Yes
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- No
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 096003541 | IL | MD | Athletic Trainer |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Athletic Trainer | 2255A2300X | 096003541 | IL | Yes |
Addresses
Primary practice location
1418 College Dr
Mount Carmel, IL 62863-2638
Mailing address
1418 College Dr
Mount Carmel, IL 62863-2638
Phone (618) 317-5256
Other providers in Mount Carmel, IL
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- Ronda Hockgeiger
- Paige Emilee Hocking
- Chelsea Ann Hon
- Martha Hooper
- Ryan Horrall
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- Maryn Houchin
All providers in Mount Carmel, IL · Athletic Trainer in Illinois
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Aug 12, 2014. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.