Provider Demographics
NPI:1225366867
Name:TRACY D. ADAMS ET AL PTR
Entity Type:Organization
Organization Name:TRACY D. ADAMS ET AL PTR
Other - Org Name:TRINITY ORTHOTICS & PEDORTHICS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER/ORTHOTIST
Authorized Official - Prefix:MR
Authorized Official - First Name:TRACY
Authorized Official - Middle Name:DELANE
Authorized Official - Last Name:ADAMS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:256-216-8376
Mailing Address - Street 1:910 W HOBBS ST
Mailing Address - Street 2:
Mailing Address - City:ATHENS
Mailing Address - State:AL
Mailing Address - Zip Code:35611-1412
Mailing Address - Country:US
Mailing Address - Phone:256-216-8376
Mailing Address - Fax:256-216-8377
Practice Address - Street 1:910 W HOBBS ST
Practice Address - Street 2:
Practice Address - City:ATHENS
Practice Address - State:AL
Practice Address - Zip Code:35611-1412
Practice Address - Country:US
Practice Address - Phone:256-216-8376
Practice Address - Fax:256-216-8377
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-11-19
Last Update Date:2011-11-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL72335E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes335E00000XSuppliersProsthetic/Orthotic Supplier
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL511-01976OtherBCBS
AL511-5872OtherBLUE CROSS BLUE SHEILD
AL511-01976OtherBCBS
AL1188490003Medicare NSC
AL1188490002Medicare NSC