Tracy Family Practice Clinic PA

Primary specialty

Preferred Provider OrganizationTaxonomy code 305R00000X

License

C7340 Issued in AR

Legal business name

TRACY FAMILY PRACTICE CLINIC PA

Practice address

1940 S Whitehead Dr
De Witt, AR 72042-2906

Phone

(870) 946-4505

Fax

(870) 946-2428

NPI assigned

Jun 4, 2006

Last updated

Sep 16, 2010By the provider in NPPES

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Dr. Wallace Lee Tracy, M.D.NPI 1366438384

Title

Owner

Phone

(870) 946-4505

Specialties & licenses 1

Addresses

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

• Wallace Lee Tracy, M.D.

  • Family Medicine Physician
  • De Witt, AR
  • NPI 1366438384
  Authorized official Same address or phone

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1149379200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1284595200000",
    "number": "1659319150",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1940 S WHITEHEAD DR",
            "city": "DE WITT",
            "state": "AR",
            "postal_code": "720422906",
            "telephone_number": "870-946-4505",
            "fax_number": "870-946-2428"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1940 S WHITEHEAD DR",
            "city": "DE WITT",
            "state": "AR",
            "postal_code": "720422906",
            "telephone_number": "870-946-4505",
            "fax_number": "870-946-2428"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "TRACY FAMILY PRACTICE CLINIC PA",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-06-04",
        "last_updated": "2010-09-16",
        "status": "A",
        "authorized_official_last_name": "TRACY",
        "authorized_official_first_name": "WALLACE",
        "authorized_official_middle_name": "LEE",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "870-946-4505",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "305R00000X",
            "taxonomy_group": "",
            "desc": "Preferred Provider Organization",
            "state": "AR",
            "license": "C7340",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• State of Arkansas
• Abby Staton, PHARM. D
• Stephen Lloyd Stewart, PA-C
• Tommys Rexall Drug Company Inc
• Tommys Rexall Drug Company Inc.
• Wallace Lee Tracy, M.D.
• Van M Dunn
• Holly Chambless Vansandt, PHARM.D
• Howard Dean Watts, P.D.
• Karen Watts, PHARMD

• Preferred Provider Organization in De Witt, AR
• Providers in De Witt, AR by specialty
• Preferred Provider Organization in Arkansas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 16, 2010; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.