Provider Demographics
NPI:1386642239
Name:MEDTRAC SOLUTIONS, INC.
Entity Type:Organization
Organization Name:MEDTRAC SOLUTIONS, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:TIMOTHY
Authorized Official - Middle Name:S
Authorized Official - Last Name:KELLEY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:615-849-8303
Mailing Address - Street 1:714 S CHURCH ST
Mailing Address - Street 2:SUITE B
Mailing Address - City:MURFREESBORO
Mailing Address - State:TN
Mailing Address - Zip Code:37130-4926
Mailing Address - Country:US
Mailing Address - Phone:615-849-8303
Mailing Address - Fax:615-849-9654
Practice Address - Street 1:714 S CHURCH ST
Practice Address - Street 2:SUITE B
Practice Address - City:MURFREESBORO
Practice Address - State:TN
Practice Address - Zip Code:37130-4926
Practice Address - Country:US
Practice Address - Phone:615-849-8303
Practice Address - Fax:615-849-9654
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-07-13
Last Update Date:2013-01-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN5296890001Medicare NSC