1902187537 NPI number — MRS. TRACY R FLEMMING-TRACY OT

Table of content: MRS. TRACY R FLEMMING-TRACY OT (NPI 1902187537)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1902187537 NPI number — MRS. TRACY R FLEMMING-TRACY OT

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
FLEMMING-TRACY
Provider First Name:
TRACY
Provider Middle Name:
R
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
OT
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:
1902187537
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
04/22/2016
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
3105 INDEPENDENCE DR
Provider Second Line Business Mailing Address:
SUITE 105
Provider Business Mailing Address City Name:
BIRMINGHAM
Provider Business Mailing Address State Name:
AL
Provider Business Mailing Address Postal Code:
35209-4111
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
205-803-2210
Provider Business Mailing Address Fax Number:
205-803-2214

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
3105 INDEPENDENCE DR
Provider Second Line Business Practice Location Address:
SUITE 105
Provider Business Practice Location Address City Name:
BIRMINGHAM
Provider Business Practice Location Address State Name:
AL
Provider Business Practice Location Address Postal Code:
35209-4111
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
205-803-2210
Provider Business Practice Location Address Fax Number:
205-803-2214
Provider Enumeration Date:
09/09/2011

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: 225X00000X , with the licence number:  2469 , registered in the state of AL ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 511-22828 . This is a "BLUE CROSS BLUE SHIELD ALABAMA" identifier , issued by the state of ( AL ) . This identifiers is of the category "OTHER".




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