MEDICARE: TRACY PRICE

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	172A00000X	Driver		OH

General Provider Information

NPI Number	:	1932610631
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	TRACY PRICE

Provider Business Mailing Address
First Line	:	PO BOX 5718
Second Line	:
City	:	TOLEDO
State	:	OH
Zip	:	43613-0718
Country	:	US
Telephone Number	:	419-517-3799
Fax Number	:

Provider Business Practice Location Address
First Line	:	4353 W SYLVANIA AVE
Second Line	:
City	:	TOLEDO
State	:	OH
Zip	:	43623-3425
Country	:	US
Telephone Number	:	419-517-3799
Fax Number	:

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

Provider Enumeration Date	:	10/20/2017
Last Update Date	:	03/17/2018

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Directions to “ TRACY PRICE ” Practice Location

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