Provider Demographics
NPI:1437245784
Name:TRI- COUNTY DIAGNOSTIC TESTING SERVICES LLC
Entity Type:Organization
Organization Name:TRI- COUNTY DIAGNOSTIC TESTING SERVICES LLC
Other - Org Name:SAINT VINCENT DIAGNOSTIC TESTING IN BRADFORD
Other - Org Type:Doing Business As
Authorized Official - Title/Position:BOARD SECRETARY
Authorized Official - Prefix:
Authorized Official - First Name:MARK
Authorized Official - Middle Name:R
Authorized Official - Last Name:KRESSE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:814-452-7888
Mailing Address - Street 1:3530 PEACH ST
Mailing Address - Street 2:SUITE LL1
Mailing Address - City:ERIE
Mailing Address - State:PA
Mailing Address - Zip Code:16508-2768
Mailing Address - Country:US
Mailing Address - Phone:814-860-5000
Mailing Address - Fax:814-860-5050
Practice Address - Street 1:52 DAVIS ST
Practice Address - Street 2:
Practice Address - City:BRADFORD
Practice Address - State:PA
Practice Address - Zip Code:16701-2016
Practice Address - Country:US
Practice Address - Phone:814-368-3150
Practice Address - Fax:814-368-4968
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:CLINICAL SERVICES INC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-10-05
Last Update Date:2007-10-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA1012141200001Medicaid
PA1012141200001Medicaid