Provider Demographics
NPI:1568424950
Name:TRI-COUNTY SURGERY
Entity Type:Organization
Organization Name:TRI-COUNTY SURGERY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:CANDY
Authorized Official - Middle Name:MARIE
Authorized Official - Last Name:GAROFALO
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:636-239-1766
Mailing Address - Street 1:1111 EAST 6TH STREET
Mailing Address - Street 2:
Mailing Address - City:WASHINGTON
Mailing Address - State:MO
Mailing Address - Zip Code:63090
Mailing Address - Country:US
Mailing Address - Phone:636-239-1766
Mailing Address - Fax:636-239-2964
Practice Address - Street 1:1111 EAST 6TH STREET
Practice Address - Street 2:
Practice Address - City:WASHINGTON
Practice Address - State:MO
Practice Address - Zip Code:63090
Practice Address - Country:US
Practice Address - Phone:636-239-1766
Practice Address - Fax:636-239-2964
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:SURGICAL CARE AFFILIATES
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-04-03
Last Update Date:2010-06-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Surgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
490002655Medicare PIN
MO000040029Medicare PIN