Provider Demographics
NPI:1619534013
Name:SMITH, TRACY ERICA
Entity Type:Individual
Prefix:
First Name:TRACY
Middle Name:ERICA
Last Name:SMITH
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1202 GLENVIEW DR
Mailing Address - Street 2:
Mailing Address - City:MOGADORE
Mailing Address - State:OH
Mailing Address - Zip Code:44260-9581
Mailing Address - Country:US
Mailing Address - Phone:330-628-1131
Mailing Address - Fax:
Practice Address - Street 1:1202 GLENVIEW DR
Practice Address - Street 2:
Practice Address - City:MOGADORE
Practice Address - State:OH
Practice Address - Zip Code:44260-9581
Practice Address - Country:US
Practice Address - Phone:330-628-1131
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-05-22
Last Update Date:2019-05-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2472R0900XTechnologists, Technicians & Other Technical Service ProvidersTechnician, OtherRenal DialysisGroup - Single Specialty