Organization
TRACEY L FOGLE
Active
Other names
Tracey's Boutique
Organization subpart
No
Provider details
NPI number
Authorized official
TRACEY L FOGLE CMF (OWNER)
(719) 424-7565
Entity
Organization
Contact information
Practice address
7862 N ACADEMY BLVD, COLORADO SPRINGS, CO 80920-3920
(719) 424-7565
(719) 559-1710
Mailing address
7862 N ACADEMY BLVD, COLORADO SPRINGS, CO 80920-3920
(719) 424-7565
(719) 559-1710
Taxonomy
Speciality
Code
Description
License number
State
224900000X
Mastectomy Fitter
—
—
332B00000X
Durable Medical Equipment & Medical Supplies
Primary
—
—
Other
Enumeration date
08/02/2019
Last updated
06/19/2024
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