Provider Demographics
NPI:1184045668
Name:TRI-CITY TECHNOLOGY SYSTEM INC
Entity Type:Organization
Organization Name:TRI-CITY TECHNOLOGY SYSTEM INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:BRENDA
Authorized Official - Middle Name:
Authorized Official - Last Name:WARD
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:469-271-2012
Mailing Address - Street 1:201 W BELT LINE RD STE C700
Mailing Address - Street 2:
Mailing Address - City:CEDAR HILL
Mailing Address - State:TX
Mailing Address - Zip Code:75104-1100
Mailing Address - Country:US
Mailing Address - Phone:469-271-2012
Mailing Address - Fax:972-291-7670
Practice Address - Street 1:201 W BELT LINE RD STE C700
Practice Address - Street 2:
Practice Address - City:CEDAR HILL
Practice Address - State:TX
Practice Address - Zip Code:75104-1100
Practice Address - Country:US
Practice Address - Phone:469-271-2012
Practice Address - Fax:972-291-7670
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-12-30
Last Update Date:2013-12-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselorGroup - Multi-Specialty
No343900000XTransportation ServicesNon-emergency Medical Transport (VAN)Group - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX4692712012OtherMEDICAID