Healthcare Provider Details

I. General information

NPI: 1710149000
Provider Name (Legal Business Name): TRACY BOSTIC CLINGAN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/27/2008
Last Update Date: 06/27/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

620 GRANDVIEW DR
HAMILTON AL
35570-4332
US

IV. Provider business mailing address

PO BOX 1941
HAMILTON AL
35570-1941
US

V. Phone/Fax

Practice location:
  • Phone: 205-495-4314
  • Fax:
Mailing address:
  • Phone: 205-921-7172
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2279H0200X
TaxonomyHome Health Registered Respiratory Therapist
License Number9359006805
License Number StateAL
# 2
Primary TaxonomyN
Taxonomy Code2279P1004X
TaxonomyPulmonary Diagnostics Registered Respiratory Therapist
License Number9359006805
License Number StateAL
# 3
Primary TaxonomyN
Taxonomy Code246W00000X
TaxonomyCardiology Technician
License Number9359006805
License Number StateAL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: