Provider Demographics
NPI:1760495923
Name:TRICOUNTY SURGICAL ASSOCIATES, PA
Entity Type:Organization
Organization Name:TRICOUNTY SURGICAL ASSOCIATES, PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BILLING SUPERVISOR
Authorized Official - Prefix:
Authorized Official - First Name:JANICE
Authorized Official - Middle Name:
Authorized Official - Last Name:TRUDEAU
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:843-797-5157
Mailing Address - Street 1:9239 MEDICAL PLAZA DR
Mailing Address - Street 2:
Mailing Address - City:CHARLESTON
Mailing Address - State:SC
Mailing Address - Zip Code:29406-9126
Mailing Address - Country:US
Mailing Address - Phone:843-797-5151
Mailing Address - Fax:843-572-6939
Practice Address - Street 1:9239 MEDICAL PLAZA DR
Practice Address - Street 2:
Practice Address - City:CHARLESTON
Practice Address - State:SC
Practice Address - Zip Code:29406-9126
Practice Address - Country:US
Practice Address - Phone:843-797-5151
Practice Address - Fax:843-572-6939
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-15
Last Update Date:2010-08-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208600000XAllopathic & Osteopathic PhysiciansSurgeryGroup - Single Specialty