Active NPI
Edmond Christopher Ina, LAT, ATC
- Athletic Trainer
- Winston Salem, NC
National Provider Identifier
1992228738
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Athletic Trainer
- License
- 1710
- Practice address
- 1901 Mooney St
Winston Salem, NC 27103-3032 - Phone
- (336) 713-5230
- NPI assigned
- Jul 24, 2017
- Sex
- Male
- Sole proprietor
- Yes
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 | 1710 | NC | Primary |
Addresses
Primary practice location
1901 Mooney St
Winston Salem, NC 27103-3032
Mailing address
1901 Mooney St
Winston Salem, NC 27103-3032
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 |
|---|---|---|---|
| 1710 | NC | MD | Marriage & Family Therapist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1500854400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1500854400000",
"number": "1992228738",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1901 MOONEY ST",
"city": "WINSTON SALEM",
"state": "NC",
"postal_code": "271033032"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1901 MOONEY ST",
"city": "WINSTON SALEM",
"state": "NC",
"postal_code": "271033032",
"telephone_number": "336-713-5230"
}
],
"practiceLocations": [],
"basic": {
"last_name": "INA",
"first_name": "EDMOND",
"middle_name": "CHRISTOPHER",
"credential": "LAT, ATC",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2017-07-24",
"last_updated": "2017-07-24",
"status": "A"
},
"taxonomies": [
{
"code": "2255A2300X",
"taxonomy_group": "",
"desc": "Specialist/Technologist, Athletic Trainer",
"state": "NC",
"license": "1710",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Winston Salem, NC
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 24, 2017; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.