Provider Demographics
NPI:1881477396
Name:TRACIE SCHARDEIN, LLC
Entity type:Organization
Organization Name:TRACIE SCHARDEIN, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:TRACIE
Authorized Official - Middle Name:
Authorized Official - Last Name:SCHARDEIN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:785-992-0275
Mailing Address - Street 1:102 S VAN BUREN ST
Mailing Address - Street 2:
Mailing Address - City:ABILENE
Mailing Address - State:KS
Mailing Address - Zip Code:67410-3705
Mailing Address - Country:US
Mailing Address - Phone:785-992-0275
Mailing Address - Fax:
Practice Address - Street 1:102 S VAN BUREN ST
Practice Address - Street 2:
Practice Address - City:ABILENE
Practice Address - State:KS
Practice Address - Zip Code:67410-3705
Practice Address - Country:US
Practice Address - Phone:785-992-0275
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-08-17
Last Update Date:2023-08-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center