MEDICARE: CARE TRACK CONSULTING LLC

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	251B00000X	Case Management Agency	AP115470	TX

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
2	TXB131306	OTHER	TX	MEDICARE

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	1548396849	OTHER	TX	INDIVIDUAL NPI

General Provider Information

NPI Number	:	1265975163
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CARE TRACK CONSULTING LLC

Provider Business Mailing Address
First Line	:	5440 HARVEST HILL RD STE 182
Second Line	:
City	:	DALLAS
State	:	TX
Zip	:	75230-1605
Country	:	US
Telephone Number	:	214-213-4726
Fax Number	:	866-672-8204

Provider Business Practice Location Address
First Line	:	5440 HARVEST HILL RD STE 182
Second Line	:
City	:	DALLAS
State	:	TX
Zip	:	75230-1605
Country	:	US
Telephone Number	:	214-213-4726
Fax Number	:	866-672-8204

Authorized Official
Title or Position	:	PROVIDER/OWNER
Name	:	SANDRA J PETERSEN
Credential	:	DNP, APRN, GNP-BC
Telephone Number	:	214-213-4726

Provider Enumeration Date	:	11/23/2016
Last Update Date	:	08/24/2017

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Directions to “CARE TRACK CONSULTING LLC ” Practice Location

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