Provider Demographics
NPI:1821129792
Name:TRI- CITY PODIATRIC PHYSICIANS & SURGEONS LTD
Entity Type:Organization
Organization Name:TRI- CITY PODIATRIC PHYSICIANS & SURGEONS LTD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:ANDI
Authorized Official - Middle Name:
Authorized Official - Last Name:DIMAGGIO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:541-347-8283
Mailing Address - Street 1:1450 POLARIS LN SW
Mailing Address - Street 2:
Mailing Address - City:BANDON
Mailing Address - State:OR
Mailing Address - Zip Code:97411-8816
Mailing Address - Country:US
Mailing Address - Phone:541-347-8283
Mailing Address - Fax:541-347-3632
Practice Address - Street 1:1450 POLARIS LN SW
Practice Address - Street 2:
Practice Address - City:BANDON
Practice Address - State:OR
Practice Address - Zip Code:97411-8816
Practice Address - Country:US
Practice Address - Phone:541-347-8283
Practice Address - Fax:541-347-3632
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-09
Last Update Date:2008-05-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR480014636OtherRAILROAD MEDICARE
OR480014636OtherRAILROAD MEDICARE
ORR140862Medicare PIN