Provider Demographics
NPI:1265535413
Name:TRI-COUNTY ORTHOPAEDIC FOOT AND ANKLE CENTER PLC
Entity type:Organization
Organization Name:TRI-COUNTY ORTHOPAEDIC FOOT AND ANKLE CENTER PLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BUSINESS MANAGER
Authorized Official - Prefix:MR
Authorized Official - First Name:RONALD
Authorized Official - Middle Name:L
Authorized Official - Last Name:WOLVERTON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:231-773-4509
Mailing Address - Street 1:1314 E APPLE AVE
Mailing Address - Street 2:
Mailing Address - City:MUSKEGON
Mailing Address - State:MI
Mailing Address - Zip Code:49442-3759
Mailing Address - Country:US
Mailing Address - Phone:231-777-2568
Mailing Address - Fax:231-773-4310
Practice Address - Street 1:1314 E APPLE AVE
Practice Address - Street 2:
Practice Address - City:MUSKEGON
Practice Address - State:MI
Practice Address - Zip Code:49442-3759
Practice Address - Country:US
Practice Address - Phone:231-777-2568
Practice Address - Fax:231-773-4310
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-06
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Not Answered207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryGroup - Single Specialty
Not Answered207XX0004XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryFoot and Ankle SurgeryGroup - Single Specialty