Provider Demographics
NPI:1184954919
Name:TRACY D. ADAMS ET AL PTR
Entity type:Organization
Organization Name:TRACY D. ADAMS ET AL PTR
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PRACTIONER
Authorized Official - Prefix:
Authorized Official - First Name:TRACY
Authorized Official - Middle Name:DELANE
Authorized Official - Last Name:ADAMS
Authorized Official - Suffix:
Authorized Official - Credentials:CO
Authorized Official - Phone:256-275-3535
Mailing Address - Street 1:1905 FLORENCE BLVD
Mailing Address - Street 2:SUITE F
Mailing Address - City:FLORENCE
Mailing Address - State:AL
Mailing Address - Zip Code:35630-2729
Mailing Address - Country:US
Mailing Address - Phone:256-275-3535
Mailing Address - Fax:
Practice Address - Street 1:1905 FLORENCE BLVD
Practice Address - Street 2:SUITE F
Practice Address - City:FLORENCE
Practice Address - State:AL
Practice Address - Zip Code:35630-2729
Practice Address - Country:US
Practice Address - Phone:256-275-3535
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:TRINITY ORTHOTICS & PEDORTHICS
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2009-12-29
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
AL511-5872OtherBLUE CROSS BLUE SHEILD OF ALABAMA
=========OtherTRICARE
=========001OtherTRICARE DME
AL511-5872OtherBLUE CROSS BLUE SHEILD OF ALABAMA