Provider Demographics
NPI:1427451905
Name:THORNTON, TRACIE MCLAIN (PA-C)
Entity type:Individual
Prefix:MS
First Name:TRACIE
Middle Name:MCLAIN
Last Name:THORNTON
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
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Mailing Address - Street 1:1 SUGAR CREEK CENTER BLVD STE 618
Mailing Address - Street 2:
Mailing Address - City:SUGAR LAND
Mailing Address - State:TX
Mailing Address - Zip Code:77478-3540
Mailing Address - Country:US
Mailing Address - Phone:832-655-4141
Mailing Address - Fax:713-457-5188
Practice Address - Street 1:1 SUGAR CREEK CENTER BLVD STE 618
Practice Address - Street 2:UNIVERSAL SURGICAL ASSISTANTS
Practice Address - City:SUGAR LAND
Practice Address - State:TX
Practice Address - Zip Code:77478-3540
Practice Address - Country:US
Practice Address - Phone:832-655-4141
Practice Address - Fax:713-457-5188
Is Sole Proprietor?:No
Enumeration Date:2014-09-29
Last Update Date:2019-07-26
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
TXPA09498363AS0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX436657YV3COtherMEDICARE P-TAN
TX8LH981OtherBCBS - BLUE STAR SURGICAL ASSISTANTS LLC
TX436657ZP6SOtherMEDICARE P-TAN
TX8354NROtherBCBS
TX8HM768OtherBCBS - UNIVERSAL SURGICAL PARTNERS
TXPA09498OtherTEXAS MEDICAL BOARD
TX8353NROtherBCBS - UNIVERSAL SURGICAL ASSISTANTS
TX8235NVOtherBCBS - XCITE SURGICAL