Provider Demographics
NPI:1811171853
Name:TRI CITY PT CARE
Entity type:Organization
Organization Name:TRI CITY PT CARE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SOLE MEMBER
Authorized Official - Prefix:
Authorized Official - First Name:MOHAMMAD
Authorized Official - Middle Name:
Authorized Official - Last Name:KAMRAN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:256-238-1154
Mailing Address - Street 1:601 LEIGHTON AVE
Mailing Address - Street 2:
Mailing Address - City:ANNISTON
Mailing Address - State:AL
Mailing Address - Zip Code:36207-5743
Mailing Address - Country:US
Mailing Address - Phone:256-240-7268
Mailing Address - Fax:256-240-7334
Practice Address - Street 1:40745 HIGHWAY 77
Practice Address - Street 2:
Practice Address - City:ASHLAND
Practice Address - State:AL
Practice Address - Zip Code:36251-4807
Practice Address - Country:US
Practice Address - Phone:256-354-3066
Practice Address - Fax:256-354-3080
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-12-27
Last Update Date:2010-03-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL084537207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL510G700149Medicare PIN