MEDICARE: EILEEN C TRACY

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	332B00000X	Durable Medical Equipment & Medical Supplies

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
2	000000016562	OTHER		ANTHEM BCBS

General Provider Information

NPI Number	:	1851479828
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	EILEEN C TRACY

Provider Business Mailing Address
First Line	:	6310 FAR HILLS AVE
Second Line	:
City	:	CENTERVILLE
State	:	OH
Zip	:	45459-2724
Country	:	US
Telephone Number	:	937-291-0010
Fax Number	:	937-291-9276

Provider Business Practice Location Address
First Line	:	6310 FAR HILLS AVE
Second Line	:
City	:	CENTERVILLE
State	:	OH
Zip	:	45459-2724
Country	:	US
Telephone Number	:	937-291-0010
Fax Number	:	937-291-9276

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

Provider Enumeration Date	:	11/01/2006
Last Update Date	:	12/14/2007

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Directions to “ EILEEN C TRACY ” Practice Location

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