Provider Demographics
NPI:1407985344
Name:TRI COUNTY MEDICAL CENTER, INC
Entity Type:Organization
Organization Name:TRI COUNTY MEDICAL CENTER, INC
Other - Org Name:YEARWOOD MEDICAL CLINIC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:MARILYN
Authorized Official - Middle Name:J
Authorized Official - Last Name:SAWYER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:251-578-1163
Mailing Address - Street 1:PO BOX 726
Mailing Address - Street 2:
Mailing Address - City:EVERGREEN
Mailing Address - State:AL
Mailing Address - Zip Code:36401-0726
Mailing Address - Country:US
Mailing Address - Phone:251-578-1163
Mailing Address - Fax:251-578-6963
Practice Address - Street 1:1 MILNER ST
Practice Address - Street 2:
Practice Address - City:FORT DEPOSIT
Practice Address - State:AL
Practice Address - Zip Code:36032-3820
Practice Address - Country:US
Practice Address - Phone:334-227-9991
Practice Address - Fax:334-227-3226
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:TRI COUNTY MEDICAL CENTER, INC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2007-03-05
Last Update Date:2008-04-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QF0400XAmbulatory Health Care FacilitiesClinic/CenterFederally Qualified Health Center (FQHC)
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL011926Medicare Oscar/Certification
ALI629Medicare PIN