Provider Demographics
NPI:1477544880
Name:TRI-COUNTY RADIOLOGISTS, INC.
Entity Type:Organization
Organization Name:TRI-COUNTY RADIOLOGISTS, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BUSINESS MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:CAROLYN
Authorized Official - Middle Name:J
Authorized Official - Last Name:WATSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:740-522-3774
Mailing Address - Street 1:2112 CHERRY VALLEY RD
Mailing Address - Street 2:P O BOX 948
Mailing Address - City:NEWARK
Mailing Address - State:OH
Mailing Address - Zip Code:43055-1323
Mailing Address - Country:US
Mailing Address - Phone:740-522-3774
Mailing Address - Fax:740-522-2221
Practice Address - Street 1:2112 CHERRY VALLEY RD
Practice Address - Street 2:
Practice Address - City:NEWARK
Practice Address - State:OH
Practice Address - Zip Code:43055-1323
Practice Address - Country:US
Practice Address - Phone:740-522-3774
Practice Address - Fax:740-522-2221
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-11-03
Last Update Date:2016-05-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic RadiologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0139960Medicaid
OHTR9913261Medicare ID - Type Unspecified