Healthcare Provider Details

I. General information

NPI: 1699560573
Provider Name (Legal Business Name): SAFETRACE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/11/2025
Last Update Date: 04/11/2025
Certification Date: 04/11/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

200 RITTENHOUSE CIR STE 9
BRISTOL PA
19007-1619
US

IV. Provider business mailing address

200 RITTENHOUSE CIR STE 9
BRISTOL PA
19007-1619
US

V. Phone/Fax

Practice location:
  • Phone: 267-600-5697
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code291U00000X
TaxonomyClinical Medical Laboratory
License Number
License Number State

VIII. Authorized Official

Name: TRACEY JOHNSON
Title or Position: PRESIDENT
Credential:
Phone: 267-600-5697