NPI 1659319150

Tracy Family Practice Clinic PA

Organisation Preferred Provider Organization De Witt, AR

Practice location

Address: 1940 S Whitehead Dr, De Witt, AR 72042-2906
Phone: (870) 946-4505
Fax: (870) 946-2428

Authorised official

Name: Wallace Lee Tracy
Title: Owner
Phone: (870) 946-4505

Registered specialties

Preferred Provider Organization Primary

Managed Care Organizations Taxonomy 305R00000X Licence C7340 (AR)

Other Preferred Provider Organization providers in Arkansas →

Registry record

NPI: 1659319150
Entity type: Organization
NPI issued: 4 Jun 2006
Record last updated: 16 Sep 2010

Reproduced from NPPES, the federal provider registry. The date above is when the provider last updated their own entry, not when we fetched it - a record can be years old and still current in the registry.