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NPI Code Detail

MEDICARE: TRACY SANDFORD POSTON PAC

MEDICARE: TRACY SANDFORD POSTON PAC
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1363A00000XPhysician Assistant2503AZ

Medicare Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1Z144795OTHERMEDICARE PTAN

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
2MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1588657662
Entity Type Code : Individual
Provider Name (Legal Business Name) : TRACY SANDFORD POSTON PAC
Provider Business Mailing Address
First Line : 3825 W MENADOTA DR
Second Line :
City : GLENDALE
State : AZ
Zip : 85308-7425
Country : US
Telephone Number : 602-690-7479
Fax Number :
Provider Business Practice Location Address
First Line : 903 N 2ND ST
Second Line :
City : PHOENIX
State : AZ
Zip : 85004-1906
Country : US
Telephone Number : 602-416-7600
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 08/24/2005
Last Update Date : 08/04/2011

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