Provider Demographics
NPI:1003890294
Name:TRI-COUNTY PULMONARY & MULTI-SPECIALTY GROUP P A
Entity Type:Organization
Organization Name:TRI-COUNTY PULMONARY & MULTI-SPECIALTY GROUP P A
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BUSINESS ADMINISTRATOR
Authorized Official - Prefix:MR
Authorized Official - First Name:DAN
Authorized Official - Middle Name:
Authorized Official - Last Name:ARSENIJEVITH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:352-350-1556
Mailing Address - Street 1:1507 BUENOS AIRES BLVD
Mailing Address - Street 2:
Mailing Address - City:THE VILLAGES
Mailing Address - State:FL
Mailing Address - Zip Code:32159-8974
Mailing Address - Country:US
Mailing Address - Phone:352-350-1600
Mailing Address - Fax:352-750-8032
Practice Address - Street 1:1507 BUENOS AIRES BLVD
Practice Address - Street 2:
Practice Address - City:THE VILLAGES
Practice Address - State:FL
Practice Address - Zip Code:32159-8974
Practice Address - Country:US
Practice Address - Phone:352-350-1600
Practice Address - Fax:352-750-8032
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-12-01
Last Update Date:2008-06-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary DiseaseGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL262056100Medicaid
FL262056100Medicaid