Healthcare Provider Details

I. General information

NPI: 1093844060
Provider Name (Legal Business Name): TRI COUNTY MEDICAL CENTER, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/05/2007
Last Update Date: 02/12/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1115 AZALEA PL
BREWTON AL
36426-1318
US

IV. Provider business mailing address

PO BOX 726
EVERGREEN AL
36401-0726
US

V. Phone/Fax

Practice location:
  • Phone: 251-809-3925
  • Fax: 251-809-6058
Mailing address:
  • Phone: 251-578-1163
  • Fax: 251-578-6963

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QD0000X
TaxonomyDental Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: MARILYN J SAWYER
Title or Position: EXECUTIVE DIRECTOR
Credential:
Phone: 251-578-1163