Provider Demographics
NPI:1992350318
Name:TRACEY L FOGLE
Entity type:Organization
Organization Name:TRACEY L FOGLE
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:TRACEY
Authorized Official - Middle Name:L
Authorized Official - Last Name:FOGLE
Authorized Official - Suffix:
Authorized Official - Credentials:CMF
Authorized Official - Phone:719-424-7565
Mailing Address - Street 1:7862 N ACADEMY BLVD
Mailing Address - Street 2:
Mailing Address - City:COLORADO SPRINGS
Mailing Address - State:CO
Mailing Address - Zip Code:80920-3920
Mailing Address - Country:US
Mailing Address - Phone:719-424-7565
Mailing Address - Fax:719-559-1710
Practice Address - Street 1:7862 N ACADEMY BLVD
Practice Address - Street 2:
Practice Address - City:COLORADO SPRINGS
Practice Address - State:CO
Practice Address - Zip Code:80920-3920
Practice Address - Country:US
Practice Address - Phone:719-424-7565
Practice Address - Fax:719-559-1710
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-08-02
Last Update Date:2024-06-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes332B00000XSuppliersDurable Medical Equipment & Medical SuppliesGroup - Multi-Specialty
No224900000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMastectomy FitterGroup - Multi-Specialty