Active NPI
Myron Jacob Cullen, ATC
- Athletic Trainer
- Bismarck, ND
National Provider Identifier
1649481656
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Athletic Trainer
- License
- 0784
- Practice address
- 310 NTH 9TH Street
Bismarck, ND 58506-5510 - Phone
- (701) 530-8100
- Fax
- (701) 530-8160
- NPI assigned
- May 24, 2007
- 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 | 0784 | ND | Primary |
Addresses
Primary practice location
310 NTH 9TH Street
Bismarck, ND 58506-5510
Mailing address
124 Riverside Park Rd
Bismarck, ND 58504-5385
Phone (701) 258-4415
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 |
|---|---|---|---|
| 0784 | ND | MD | Athletic Trainer |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1179964800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1183852800000",
"number": "1649481656",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "124 RIVERSIDE PARK RD",
"city": "BISMARCK",
"state": "ND",
"postal_code": "585045385",
"telephone_number": "701-258-4415"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "310 NTH 9TH STREET",
"city": "BISMARCK",
"state": "ND",
"postal_code": "585065510",
"telephone_number": "701-530-8100",
"fax_number": "701-530-8160"
}
],
"practiceLocations": [],
"basic": {
"last_name": "CULLEN",
"first_name": "MYRON",
"middle_name": "JACOB",
"name_prefix": "Mr.",
"credential": "ATC",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2007-05-24",
"last_updated": "2007-07-08",
"status": "A"
},
"taxonomies": [
{
"code": "2255A2300X",
"taxonomy_group": "",
"desc": "Specialist/Technologist, Athletic Trainer",
"state": "ND",
"license": "0784",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Bismarck, ND
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.