Provider Demographics
NPI:1457908683
Name:TUSC COUNTY MEDICAL SPECIALIST LLC
Entity Type:Organization
Organization Name:TUSC COUNTY MEDICAL SPECIALIST LLC
Other - Org Name:TUSC COUNTY MEDICAL SPECIALIST
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT/MD
Authorized Official - Prefix:
Authorized Official - First Name:CHARLES
Authorized Official - Middle Name:V
Authorized Official - Last Name:BARRETT
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:330-364-4600
Mailing Address - Street 1:PO BOX 3475
Mailing Address - Street 2:
Mailing Address - City:PITTSBURGH
Mailing Address - State:PA
Mailing Address - Zip Code:15230-3475
Mailing Address - Country:US
Mailing Address - Phone:330-364-4600
Mailing Address - Fax:330-364-3338
Practice Address - Street 1:300 MEDICAL PARK DR
Practice Address - Street 2:SUITE 205
Practice Address - City:DOVER
Practice Address - State:OH
Practice Address - Zip Code:44622-2073
Practice Address - Country:US
Practice Address - Phone:330-364-4600
Practice Address - Fax:330-364-3338
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-08-22
Last Update Date:2020-02-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty