Individual
EILEEN C TRACY
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
6310 FAR HILLS AVE, CENTERVILLE, OH 45459-2724
(937) 291-0010
(937) 291-9276
Mailing address
6310 FAR HILLS AVE, CENTERVILLE, OH 45459-2724
(937) 291-0010
(937) 291-9276
Taxonomy
Speciality
Code
Description
License number
State
332B00000X
Durable Medical Equipment & Medical Supplies
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000000016562
ANTHEM BCBS
—
05
—
0626531
—
OH
Enumeration date
11/01/2006
Last updated
12/14/2007
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