Healthcare Provider Details

I. General information

NPI: 1649375452
Provider Name (Legal Business Name): TRI COUNTY SURGERY CENTER LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/14/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

319 2ND STREET PIKE
SOUTHAMPTON PA
18966-3812
US

IV. Provider business mailing address

319 2ND STREET PIKE
SOUTHAMPTON PA
18966-3812
US

V. Phone/Fax

Practice location:
  • Phone: 215-355-4428
  • Fax: 215-355-0790
Mailing address:
  • Phone: 215-355-4428
  • Fax: 215-355-0790

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QS0132X
TaxonomyOphthalmologic Surgery Clinic/Center
License Number1763
License Number StatePA

VIII. Authorized Official

Name: DR. RICHARD BLAIR PRINCE
Title or Position: PRESIDENT - OPHTHALMOLOGIST
Credential: M.D.
Phone: 215-396-4211