Wallace L Tracy (NPI# 1366438384, PAC ID# 3274659495) is a physician enrolled in Centers for Medicare & Medicaid Services (CMS). The primary specialty is FAMILY MEDICINE.
| Nation Provider ID (NPI) | 1366438384 |
| PAC ID by PECOS | 3274659495 |
| Professional Enrollment ID | I20100924001157 |
| Full Name | Wallace L Tracy |
| Address |
1940 S Whitehead Dr Dewitt AR 72042-2906 |
| Gender | M |
| Medical School | UNIVERSITY OF ARKANSAS COLLEGE OF MEDICINE |
| Graduation Year | 1987 |
| Primary Specialty | FAMILY MEDICINE |
| Accepts Medicare Assignment | Y |
| Claim Control Number (CCN) | Legal Business Name |
|---|---|
| 041314 | DEWITT HOSPITAL & NURSING HOME, INC |
| 040072 | BAPTIST HEALTH MEDICAL CENTER-STUTTGART |
| Address | Phone | Organization |
|---|---|---|
| 1641 S Whitehead Dr, De Witt, AR 72042-2994 | 8709463571 | DEWITT HOSPITAL AND NURSING HOME INC |
| 1940 S Whitehead Dr, Dewitt, AR 72042-2906 |
| Street Address |
1940 S WHITEHEAD DR |
| City | DEWITT |
| State | AR |
| Zip | 72042-2906 |
| Name | Specialty | Organization | Address |
|---|---|---|---|
| Dana Renee Reed | Nurse Practitioner | Dewitt Hospital and Nursing Home Inc | 1641 S Whitehead Dr, De Witt, AR 72042-2994 |
| Ralph Martin Maxwell | General Practice | Dewitt Hospital and Nursing Home Inc | 1641 S Whitehead Dr, De Witt, AR 72042-2994 |
| Tracy L Bennett | Nurse Practitioner | Dewitt Hospital and Nursing Home Inc | 1641 S Whitehead Dr, De Witt, AR 72042-2994 |
| Jason K Morris | Interventional Pain Management | Dewitt Hospital and Nursing Home Inc | 1641 S Whitehead Dr, De Witt, AR 72042-2994 |
| Philip J Terry | Family Practice | Dewitt Hospital and Nursing Home Inc | 1641 S Whitehead Dr, De Witt, AR 72042-2994 |
| Van Michael Dunn | Optometry | 609 W 13th St, De Witt, AR 72042-3001 | |
| Jennifer K Wingfield | Physical Therapy | 1626 S Madison St, De Witt, AR 72042-3003 | |
| Heidi Duffield | Physical Therapy | Grand Prairie Physical Therapy, Inc. | 317 W 7th St, Dewitt, AR 72042-3279 |
| Stanley W Burleson | Family Medicine | 705 W 16th St, Dewitt, AR 72042-3414 |
| City | DEWITT |
| Zip Code | 72042 |
| Specialty | FAMILY MEDICINE |
| City + Specialty | DEWITT + FAMILY MEDICINE |
Please comment or provide details below to improve the information on Wallace L Tracy.
| Data Provider | Centers for Medicare & Medicaid Services (CMS) |
| Jurisdiction | Medicare |
This dataset includes 1.12 million groups, individual physicians, and other clinicians currently enrolled in Medicare. Each physician is registered with NPI, PAC ID, full name, specialty, phone, organization, hospital, address, medical school, etc.