Healthcare Provider Details

I. General information

NPI: 1619928223
Provider Name (Legal Business Name): TRACC, PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/16/2006
Last Update Date: 08/31/2020
Certification Date: 08/31/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

757 8TH AVE STE 1
FORT WORTH TX
76104-2522
US

IV. Provider business mailing address

PO BOX 1559
GRANBURY TX
76048-8559
US

V. Phone/Fax

Practice location:
  • Phone: 817-332-9957
  • Fax: 817-336-3130
Mailing address:
  • Phone: 817-332-9957
  • Fax: 817-336-3130

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2086S0127X
TaxonomyTrauma Surgery Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. DAVID C SMITH
Title or Position: PRESIDENT
Credential: M.D.
Phone: 817-332-9957