Tracey A Antill, D.O.
Individual provider Active NPI Emergency Medicine Physician · Alvin, TX
NPI 1497730303 · NPPES record last updated Nov 30, 2015
Key facts
- NPI
- 1497730303
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Emergency Medicine Physician 207P00000X
- License
- K2308 (TX)
- Practice address
- 301 Medic LN
Alvin, TX 77511-5542 - Phone
- (281) 331-6141
- Fax
- (281) 331-3316
- NPI assigned
- Dec 13, 2005
- Sex
- Male
- Sole proprietor
- No
Organizations & group practices 7
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in TX
- Eligible to order & refer
- Part B services: Yes · DME: Yes · Home health: Yes · Power mobility devices: Yes · Hospice: Yes
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20100614000355 | TX | Practitioner - Emergency Medicine | 9537115639 | Reassigns benefits to 5 organizations |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
- Credentials
- Doctor of Osteopathy, Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| K2308 | TX | MD | Emergency Medicine Physician |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Bryan Emergency Physicians PA | Emergency Medicine | Current |
Accepting new patients |
| Texana Physicians, PLLC | Emergency Medicine | Current |
Accepting new patients |
| Aic Urgent Care. PLLC | Emergency Medicine | Current |
Accepting new patients |
| Brazos Valley Emergency Physicians PA | Emergency Medicine | Current |
Accepting new patients |
| Century Integrated Partners, Inc | Emergency Medicine | Current |
Accepting new patients |
| Greater Houston Emergency Physicians PLLC | Emergency Medicine | Past | Accepting new patients |
| Erlc Physician Staffing Company LLC | Emergency Medicine | Past | Accepting new patients |
Locations
3128 S Highway 35
Alvin, TX 77511
Phone (281) 886-8964
3128 S Highway 35
#C
Alvin, TX 77511
Phone (281) 886-8964
2801 Franciscan Dr
Bryan, TX 77802
Phone (409) 776-3777
3500 Gaston Ave
Dallas, TX 75246
1400 8th Ave
Ft Worth, TX 76104
Phone (817) 922-1559
2808 61st St
Ste 200
Galveston, TX 77551
Phone (281) 886-8964
2600 FM 1764 Rd
Ste 190
La Marque, TX 77568
Phone (281) 886-8964
2530 Gulf Fwy S
League City, TX 77573
Phone (281) 337-7500
210 S Judson St
Navasota, TX 77868
Phone (936) 825-6585
4700 Alliance Blvd
#P
Plano, TX 75093
Phone (469) 814-2000
200 Blossom St
Webster, TX 77598
Phone (281) 252-7000
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Emergency Medicine Physician | 207P00000X | K2308 | TX | Yes |
Addresses
Primary practice location
301 Medic LN
Alvin, TX 77511-5542
Mailing address
PO Box 200993
Houston, TX 77216-0993
Phone (281) 784-1111
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1497730303 | Other | TX | TRICARE SOUTH |
| 131166408 | Medicaid | TX | |
| 8F9296 | Other | TX | BCBSTX PROV NO |
| 131166409 | Medicaid | TX |
Other providers in Alvin, TX
- American Care EMS Inc
- Amplifon Hearing Aid Centers
- Omegie Linda Anabor
- Angela Marteeny PLLC
- Angels Quality Care, Inc.
- Apexcore Clinical Labs LLC
- Olga Alicia Arias
- Erin Arvie
- Angela Renee Attaway
- Moustafa Tarek Badawi
All providers in Alvin, TX · Emergency Medicine Physician in Texas
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Nov 30, 2015. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Order and Referring (CMS).
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.