1245575042 NPI number — TRACY C WOODS NP

Table of content: TRACY C WOODS NP (NPI 1245575042)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1245575042 NPI number — TRACY C WOODS NP

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
WOODS
Provider First Name:
TRACY
Provider Middle Name:
C
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
NP
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:
1245575042
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
12/06/2012
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
3450 W CENTRAL AVE STE 230
Provider Second Line Business Mailing Address:
HCR MANORCARE MEDICAL SERVICES OF FLORIDA, LLC
Provider Business Mailing Address City Name:
TOLEDO
Provider Business Mailing Address State Name:
OH
Provider Business Mailing Address Postal Code:
43606-1417
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
800-375-5495
Provider Business Mailing Address Fax Number:
800-564-5952

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
6300 W 95TH ST
Provider Second Line Business Practice Location Address:
HEARTLAND CARE PARTNERS
Provider Business Practice Location Address City Name:
OAK LAWN
Provider Business Practice Location Address State Name:
IL
Provider Business Practice Location Address Postal Code:
60453-2256
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
800-375-5495
Provider Business Practice Location Address Fax Number:
800-564-5952
Provider Enumeration Date:
12/05/2012

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: 363L00000X , with the licence number:  209009993 , registered in the state of ID ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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