1629249669 NPI number — TRACY STUEBER

Table of content: TRACY STUEBER (NPI 1629249669)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1629249669 NPI number — TRACY STUEBER

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
STUEBER
Provider First Name:
TRACY
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1629249669
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
09/20/2019
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1272 GARRISON DR
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
MURFREESBORO
Provider Business Mailing Address State Name:
TN
Provider Business Mailing Address Postal Code:
37129-2598
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
615-893-4480
Provider Business Mailing Address Fax Number:
615-867-7946

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
99 WHITE BRIDGE RD STE 106
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
NASHVILLE
Provider Business Practice Location Address State Name:
TN
Provider Business Practice Location Address Postal Code:
37205-1449
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
615-354-8011
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
03/18/2008

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 231H00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: A01499 . This is a "MEDICAL LICENSE" identifier , issued by the state of ( TN ) . This identifiers is of the category "OTHER".