Peter A Trace, M.D.

LBN: Peter A Trace, M.D.
Peter A Trace, M.D. is an health care organization with primary practice located at 1600 W Walnut St , Jacksonville IL 62650-1136. The organization recently has only one registered license in Allopathic & Osteopathic Physicians / Obstetrics & Gynecology, which is considered as the primary health care specialty. Peter A Trace, M.D. can be contacted via phone (217) 243-8455, or through Trace, Peter Alexander via phone (217) 243-8455.

Contact Information

Primary practice address
1600 W Walnut St Jacksonville IL 62650-1136
Phone: (217) 243-8455
Fax:
Website:
Map and Directions
Authorized official contact:
Name: Trace, Peter Alexander Doctor of Medicine (MD)
Phone: (217) 243-8455

Health care specialties

SpecialtyCodeLicense #State
Allopathic & Osteopathic Physicians / Obstetrics & Gynecology 207V00000X

Profile Details

NPI number 1538364393
LBN Legal business name Peter A Trace, M.D.
DBA Doing business as
Authorized official Trace, Peter Alexander Doctor of Medicine (MD)
Entity Organization
Organization subpart 1 No
Enumeration date Jun 20th, 2007
Last updated Jun 1st, 2009 - about 16 years ago

1 Some organizations, which are providing health care services, may consist of units or departments that provide different types of health care services or have several separate physical locations, where health care service is provided. These units, departments or physical locations are not themselves legal entities. However, each of them is part of the organization, which is a legal entity. The organization may decide whether its subparts, if it has any, should have their own NPI numbers. In case a subpart conducts any HIPAA standard transactions by itself, without its parent's involvement, it must have its own NPI number.

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Identifiers

StateTypeNumberIssuer
All States NPI 1538364393 NPPES
Illinois MEDICAID 036048526
Illinois Other 06900105
Illinois Other 06900105
Illinois Other 13127
Illinois Other 010986
Illinois Other 127838

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