1902805534 NPI number — TRACEY A SCHMUCKER M.D.

Table of content: TRACEY A SCHMUCKER M.D. (NPI 1902805534)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1902805534 NPI number — TRACEY A SCHMUCKER M.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
SCHMUCKER
Provider First Name:
TRACEY
Provider Middle Name:
A
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
M.D.
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:
1902805534
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
05/04/2011
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
105 CENTRAL AVE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
SEARCY
Provider Business Mailing Address State Name:
AR
Provider Business Mailing Address Postal Code:
72143-7329
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
501-268-7154
Provider Business Mailing Address Fax Number:
501-268-9071

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
105 CENTRAL AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
SEARCY
Provider Business Practice Location Address State Name:
AR
Provider Business Practice Location Address Postal Code:
72143-7329
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
501-268-7154
Provider Business Practice Location Address Fax Number:
501-268-9071
Provider Enumeration Date:
07/15/2005

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: 207W00000X , with the licence number:  E3864 , registered in the state of AR ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 04010020700 . This is a "QUALCHOICE" identifier , issued by the state of ( AR ) . This identifiers is of the category "OTHER".
  • Identifier: 2335915 . This is a "UNITED HEALTHCARE" identifier , issued by the state of ( AR ) . This identifiers is of the category "OTHER".
  • Identifier: 7616013 . This is a "CIGNA" identifier , issued by the state of ( AR ) . This identifiers is of the category "OTHER".
  • Identifier: 54723 . This is a "COORDINATED VISION CARE" identifier , issued by the state of ( AR ) . This identifiers is of the category "OTHER".
  • Identifier: 7144524 . This is a "AETNA" identifier , issued by the state of ( AR ) . This identifiers is of the category "OTHER".
  • Identifier: 5B955 . This is a "BLUE CROSS PAY TO" identifier , issued by the state of ( AR ) . This identifiers is of the category "OTHER".
  • Identifier: 621710274 . This is a "TAX ID" identifier , issued by the state of ( AR ) . This identifiers is of the category "OTHER".
  • Identifier: P00081947 . This is a "RAILROAD MEDICARE" identifier , issued by the state of ( AR ) . This identifiers is of the category "OTHER".
  • Identifier: 5M726 . This is a "BLUE CROSS INDIVIDUAL" identifier , issued by the state of ( AR ) . This identifiers is of the category "OTHER".
  • Identifier: CJ3133 . This is a "RAILROAD MCARE GROUP" identifier , issued by the state of ( AR ) . This identifiers is of the category "OTHER".
  • Identifier: 152290001 , issued by the state of ( AR ) . This identifiers is of the category "MEDICAID".




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