Provider Demographics
NPI:1629244744
Name:TRI-CITY PHYSICIAN SERVICES INC
Entity Type:Organization
Organization Name:TRI-CITY PHYSICIAN SERVICES INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO / PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:KATHLEEN
Authorized Official - Middle Name:ELLEN
Authorized Official - Last Name:LLOYD
Authorized Official - Suffix:
Authorized Official - Credentials:CMA
Authorized Official - Phone:804-458-8188
Mailing Address - Street 1:406 RIVERSIDE AVE
Mailing Address - Street 2:P O BOX 1537
Mailing Address - City:HOPEWELL
Mailing Address - State:VA
Mailing Address - Zip Code:23860-2828
Mailing Address - Country:US
Mailing Address - Phone:804-458-8188
Mailing Address - Fax:804-458-2555
Practice Address - Street 1:406 RIVERSIDE AVE
Practice Address - Street 2:
Practice Address - City:HOPEWELL
Practice Address - State:VA
Practice Address - Zip Code:23860-2828
Practice Address - Country:US
Practice Address - Phone:804-458-8188
Practice Address - Fax:804-458-2555
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-05-08
Last Update Date:2008-05-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty