Healthcare Provider Details

I. General information

NPI: 1275503195
Provider Name (Legal Business Name): TRI-COUNTY ANESTHESIA AND PAIN MANAGEMENT PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/24/2006
Last Update Date: 07/21/2022
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

211 VIRGINIA RD ANESTHESIA DEPT
EDENTON NC
27932-9668
US

IV. Provider business mailing address

PO BOX 1080
EDENTON NC
27932-1080
US

V. Phone/Fax

Practice location:
  • Phone: 252-482-6744
  • Fax:
Mailing address:
  • Phone: 706-860-2701
  • Fax: 706-737-2271

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License Number
License Number StateNC
# 2
Primary TaxonomyN
Taxonomy Code207LP2900X
TaxonomyPain Medicine (Anesthesiology) Physician
License Number
License Number StateNC

VIII. Authorized Official

Name: CHRISTOPHER MORROW JUSTIS
Title or Position: PRESIDENT
Credential: MD
Phone: 252-482-6744