Provider Demographics
NPI:1043208283
Name:TRACEY A. SCHMUCKER, M.D., P.A.
Entity Type:Organization
Organization Name:TRACEY A. SCHMUCKER, M.D., P.A.
Other - Org Name:LOWERY SURGERY CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:TRACEY
Authorized Official - Middle Name:A
Authorized Official - Last Name:SCHMUCKER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:501-268-7154
Mailing Address - Street 1:105 CENTRAL AVENUE
Mailing Address - Street 2:
Mailing Address - City:SEARCY
Mailing Address - State:AR
Mailing Address - Zip Code:72143
Mailing Address - Country:US
Mailing Address - Phone:501-268-7154
Mailing Address - Fax:501-268-9071
Practice Address - Street 1:105 CENTRAL AVENUE
Practice Address - Street 2:
Practice Address - City:SEARCY
Practice Address - State:AR
Practice Address - Zip Code:72143
Practice Address - Country:US
Practice Address - Phone:501-268-7154
Practice Address - Fax:501-268-9071
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-10-12
Last Update Date:2017-03-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARAR5086261QA1903X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Surgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR474406Medicare PIN