MEDICARE: TRACEY WILLIAMS

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
1	261QH0100X	Health Service Clinic/Center

Other Identifiers

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

General Provider Information

NPI Number	:	1265063622
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	TRACEY WILLIAMS

Provider Business Mailing Address
First Line	:	541 FOREST AVE
Second Line	:
City	:	GREENWOOD
State	:	IN
Zip	:	46143-1744
Country	:	US
Telephone Number	:	317-937-5732
Fax Number	:

Provider Business Practice Location Address
First Line	:	55 S STATE AVE
Second Line	:
City	:	INDIANAPOLIS
State	:	IN
Zip	:	46201-3802
Country	:	US
Telephone Number	:	317-937-5732
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	02/03/2020
Last Update Date	:	02/03/2020

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Directions to “ TRACEY WILLIAMS ” Practice Location

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