Provider Demographics
NPI:1073616215
Name:TRI-COUNTY ORTHOPAEDIC ASSOCIATES PLC
Entity Type:Organization
Organization Name:TRI-COUNTY ORTHOPAEDIC ASSOCIATES PLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRACTICE MANAGER
Authorized Official - Prefix:MS
Authorized Official - First Name:GLORIA
Authorized Official - Middle Name:M
Authorized Official - Last Name:SLATER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:231-773-4509
Mailing Address - Street 1:1314 E APPLE AVE
Mailing Address - Street 2:
Mailing Address - City:MUSKEGON
Mailing Address - State:MI
Mailing Address - Zip Code:49442-3759
Mailing Address - Country:US
Mailing Address - Phone:231-777-2568
Mailing Address - Fax:231-773-4310
Practice Address - Street 1:1314 E APPLE AVE
Practice Address - Street 2:
Practice Address - City:MUSKEGON
Practice Address - State:MI
Practice Address - Zip Code:49442-3759
Practice Address - Country:US
Practice Address - Phone:231-777-2568
Practice Address - Fax:231-773-4310
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-06
Last Update Date:2011-01-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI6400540001Medicare NSC