Healthcare Provider Details

I. General information

NPI: 1265908347
Provider Name (Legal Business Name): MRACEK FAMILY & INTERNAL MEDICINE CLINIC PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/16/2018
Last Update Date: 10/16/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

807 JACKSON TRACE RD
WETUMPKA AL
36092-1504
US

IV. Provider business mailing address

807 JACKSON TRACE RD
WETUMPKA AL
36092-1504
US

V. Phone/Fax

Practice location:
  • Phone: 334-567-3150
  • Fax: 334-567-3152
Mailing address:
  • Phone: 334-567-3150
  • Fax: 334-567-3152

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QP2300X
TaxonomyPrimary Care Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: DR. JAMES F MRACEK II
Title or Position: OWNER
Credential: MD
Phone: 334-567-3150