Provider Demographics
NPI:1477595965
Name:TRI-COUNTY AFFILIATED, INC
Entity Type:Organization
Organization Name:TRI-COUNTY AFFILIATED, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANGER
Authorized Official - Prefix:
Authorized Official - First Name:JOY
Authorized Official - Middle Name:LYNETTE
Authorized Official - Last Name:MARSHALL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:248-569-8200
Mailing Address - Street 1:21580 GREENFIELD RD
Mailing Address - Street 2:
Mailing Address - City:OAK PARK
Mailing Address - State:MI
Mailing Address - Zip Code:48237-3006
Mailing Address - Country:US
Mailing Address - Phone:248-569-8200
Mailing Address - Fax:248-569-8201
Practice Address - Street 1:21580 GREENFIELD RD
Practice Address - Street 2:
Practice Address - City:OAK PARK
Practice Address - State:MI
Practice Address - Zip Code:48237-3006
Practice Address - Country:US
Practice Address - Phone:248-569-8200
Practice Address - Fax:248-569-8201
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-11
Last Update Date:2008-09-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center
Provider Identifiers
StateIdentifier IDID TypeIssuer
MION76390Medicare ID - Type UnspecifiedGROUP PROVIDER NUMBER