Provider Demographics
NPI:1679658371
Name:TRI COUNTY MEDICAL CENTER INC
Entity Type:Organization
Organization Name:TRI COUNTY MEDICAL CENTER INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:MARILYN
Authorized Official - Middle Name:J
Authorized Official - Last Name:SAWYER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:251-578-1163
Mailing Address - Street 1:PO BOX 726
Mailing Address - Street 2:316 SOUTH MAIN STREET
Mailing Address - City:EVERGREEN
Mailing Address - State:AL
Mailing Address - Zip Code:36401-0726
Mailing Address - Country:US
Mailing Address - Phone:251-578-1163
Mailing Address - Fax:251-578-1163
Practice Address - Street 1:316 S MAIN ST
Practice Address - Street 2:
Practice Address - City:EVERGREEN
Practice Address - State:AL
Practice Address - Zip Code:36401-3325
Practice Address - Country:US
Practice Address - Phone:251-578-1163
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-25
Last Update Date:2008-04-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty
No122300000XDental ProvidersDentistGroup - Multi-Specialty
No207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL630000017Medicaid
ALCD9346OtherRAILROAD MEDICARE GROUP
ALDD4470OtherRAILROAD MEDICAID GROUP
ALCD9346OtherRAILROAD MEDICARE GROUP
ALH295Medicare PIN