# MISSOURI STATE UNIVERSITY ATHLETIC TRAINING SERVICESIS

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1427021765
- **Authorized official:** MR. IVAN EUGENE MILTON A.T. (DIRECTOR ATHLETIC TRAINING SERVICES)
- **Authorized official phone:** (417) 836-5461

## Contact information

- **Practice address:** 901 S NATIONAL AVE, SPRINGFIELD, MO 65804-0027
- **Practice address phone:** (417) 836-5461
- **Practice address fax:** (417) 836-6101
- **Mailing address:** 901 S NATIONAL AVE, SPRINGFIELD, MO 65804-0027
- **Mailing address phone:** (417) 836-5461
- **Mailing address fax:** (417) 836-6101

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 261Q00000X | Clinic/Center | — | MO | Yes |

## Other

- **Enumeration date:** 02/08/2006
- **Last updated:** 08/22/2020