Basic Information
| Provider Information | |||||||||
| NPI: | 1033199898 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | HICKS | ||||||||
| FirstName: | TRACY | ||||||||
| MiddleName: | |||||||||
| NamePrefix: | DR. | ||||||||
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| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 13700 ST FRANCIS BLVD | ||||||||
| Address2: | SUITE 305 | ||||||||
| City: | MIDLOTHIAN | ||||||||
| State: | VA | ||||||||
| PostalCode: | 231143222 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8043202483 | ||||||||
| FaxNumber: | 8044191860 | ||||||||
| Practice Location | |||||||||
| Address1: | 13700 ST FRANCIS BLVD | ||||||||
| Address2: | SUITE 305 | ||||||||
| City: | MIDLOTHIAN | ||||||||
| State: | VA | ||||||||
| PostalCode: | 231143222 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8043202483 | ||||||||
| FaxNumber: | 8044191860 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 01/18/2006 | ||||||||
| LastUpdateDate: | 06/21/2013 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207V00000X | 0101051067 | VA | Y | Allopathic & Osteopathic Physicians | Obstetrics & Gynecology |
ID Information
| ID | Type | State | Issuer | Description | 0000133671506 | 01 | UNITED | OTHER | 11938 | 01 | CARENET | OTHER | 94539 | 01 | SOUTHERN HEALTH | OTHER | C09633 | 01 | VA | GROUP PTAN | OTHER | 6201083 | 01 | VA PREMIER | OTHER | 226116 | 01 | ANTHEM | OTHER | 541941044102 | 01 | TRICARE | OTHER | 160049264 | 01 | RR MEDICARE | OTHER | 330713 | 01 | MAMSI | OTHER | 69493 | 01 | OPTIMA HEALTH | OTHER | 006201083 | 05 | VA | MEDICAID | 69493 | 01 | SENTARA | OTHER | 9276110 | 01 | CIGNA | OTHER | 0861892 | 01 | AETNA USHEALTH | OTHER |