Healthcare Provider Details

I. General information

NPI: 1194287086
Provider Name (Legal Business Name): TRI-COUNTY PRIMARY CARE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/01/2019
Last Update Date: 04/01/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

200 N EASTON
ALLEN OK
74825-9713
US

IV. Provider business mailing address

PO BOX 170
OZARK AR
72949-0170
US

V. Phone/Fax

Practice location:
  • Phone: 580-857-1300
  • Fax: 833-243-7203
Mailing address:
  • Phone: 866-243-7203
  • Fax: 833-243-7203

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: DAVID W CAMPBELL
Title or Position: OWNER
Credential:
Phone: 580-857-1300