Provider Demographics
NPI:1245841048
Name:TRACEY L HAMOR LLC
Entity type:Organization
Organization Name:TRACEY L HAMOR LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER/CEO
Authorized Official - Prefix:MRS
Authorized Official - First Name:TRACEY
Authorized Official - Middle Name:LYNN
Authorized Official - Last Name:HAMOR
Authorized Official - Suffix:
Authorized Official - Credentials:NP
Authorized Official - Phone:402-840-9896
Mailing Address - Street 1:140 N. 4TH STREET
Mailing Address - Street 2:PO BOX 208
Mailing Address - City:ELMWOOD
Mailing Address - State:NE
Mailing Address - Zip Code:68349-6027
Mailing Address - Country:US
Mailing Address - Phone:402-840-9896
Mailing Address - Fax:470-275-0883
Practice Address - Street 1:221 S 4TH ST
Practice Address - Street 2:
Practice Address - City:ELMWOOD
Practice Address - State:NE
Practice Address - Zip Code:68349-6027
Practice Address - Country:US
Practice Address - Phone:402-840-9896
Practice Address - Fax:470-275-0883
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-08-14
Last Update Date:2022-11-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental HealthGroup - Single Specialty
No261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)