Provider Demographics
NPI:1801853585
Name:TRI COUNTY FAMILY MEDICINE
Entity Type:Organization
Organization Name:TRI COUNTY FAMILY MEDICINE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:THOMAS
Authorized Official - Middle Name:F
Authorized Official - Last Name:MENDOLIA
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:336-835-5688
Mailing Address - Street 1:201 WEST MAIN STREET
Mailing Address - Street 2:
Mailing Address - City:ELKIN
Mailing Address - State:NC
Mailing Address - Zip Code:28621
Mailing Address - Country:US
Mailing Address - Phone:336-835-5688
Mailing Address - Fax:336-835-6521
Practice Address - Street 1:3369 CLINGMAN ROAD
Practice Address - Street 2:
Practice Address - City:RONDA
Practice Address - State:NC
Practice Address - Zip Code:28670
Practice Address - Country:US
Practice Address - Phone:336-835-5688
Practice Address - Fax:336-835-6521
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-04-27
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC23065173000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes173000000XOther Service ProvidersLegal MedicineGroup - Single Specialty