Provider Demographics
NPI:1821347196
Name:TRACUT LLC
Entity Type:Organization
Organization Name:TRACUT LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHEIF MANAGER
Authorized Official - Prefix:DR
Authorized Official - First Name:MITCHELL
Authorized Official - Middle Name:
Authorized Official - Last Name:WIATRAK
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:615-327-2055
Mailing Address - Street 1:345 23RD AVE N
Mailing Address - Street 2:212
Mailing Address - City:NASHVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37203-1513
Mailing Address - Country:US
Mailing Address - Phone:615-327-2055
Mailing Address - Fax:
Practice Address - Street 1:345 23RD AVE N
Practice Address - Street 2:212
Practice Address - City:NASHVILLE
Practice Address - State:TN
Practice Address - Zip Code:37203-1513
Practice Address - Country:US
Practice Address - Phone:615-327-2055
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:CENTER FOR UROLOGICAL TREATMENT
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2012-09-02
Last Update Date:2012-09-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center