MEDICARE: TRACERALLEN MEDICAL

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	332BC3200X	Customized Equipment (DME)

General Provider Information

NPI Number	:	1447693783
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	TRACERALLEN MEDICAL

Provider Business Mailing Address
First Line	:	4226 ISLE VISTA AVE
Second Line	:
City	:	BELLE ISLE
State	:	FL
Zip	:	32812-2224
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	4226 ISLE VISTA AVE
Second Line	:
City	:	BELLE ISLE
State	:	FL
Zip	:	32812-2224
Country	:	US
Telephone Number	:	407-492-4597
Fax Number	:

Authorized Official
Title or Position	:	MANAGER/ OWNER
Name	:	PATRICK TOMASSI
Credential	:
Telephone Number	:	407-492-4597

Provider Enumeration Date	:	04/16/2013
Last Update Date	:	04/16/2013

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Directions to “TRACERALLEN MEDICAL ” Practice Location

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