William Connor Imboden, MAT, ATC, LAT

Primary specialty

Athletic TrainerTaxonomy code 2255A2300X

License

2020027571 Issued in MO

Practice address

123 Leon Hall Pkwy # 3419
Hillsboro, MO 63050-3419

Phone

(217) 204-2400

NPI assigned

Dec 3, 2020

Sex

Male

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Electronic endpoints 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1606953600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1606953600000",
    "number": "1992300230",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2208 BENSON RD",
            "city": "JACKSONVILLE",
            "state": "IL",
            "postal_code": "626506547",
            "telephone_number": "217-204-2400"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "123 LEON HALL PKWY # 3419",
            "city": "HILLSBORO",
            "state": "MO",
            "postal_code": "630503419",
            "telephone_number": "217-204-2400"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "IMBODEN",
        "first_name": "WILLIAM",
        "middle_name": "CONNOR",
        "credential": "MAT, ATC, LAT",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2020-12-03",
        "last_updated": "2020-12-03",
        "certification_date": "2020-12-03",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "2255A2300X",
            "taxonomy_group": "",
            "desc": "Specialist/Technologist, Athletic Trainer",
            "state": "MO",
            "license": "2020027571",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "wcimbod1@mercy.net",
            "affiliation": "N",
            "endpointDescription": "Work email",
            "use": "DIRECT",
            "useDescription": "Direct",
            "contentType": "CSV",
            "contentTypeDescription": "CSV",
            "address_1": "123 Leon Hall Pkwy # 3419",
            "city": "Hillsboro",
            "state": "MO",
            "country_code": "US",
            "postal_code": "630503419",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

• Hillsboro Sports Medicine P.C.
• Samantha Holman
• Kelsey Taylor Holmes
• Hannah Horn
• Wilma Hueter
• Robert Janis
• Jefferson County Health Department
• Jefferson County Patient Care Services
• Jefferson Franklin Community Action Corp
• Kristena Ann Johnson, LMSW

• Athletic Trainer in Hillsboro, MO
• Providers in Hillsboro, MO by specialty
• Athletic Trainer in Missouri

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 3, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.