Healthcare Provider Details

I. General information

NPI: 1407196314
Provider Name (Legal Business Name): TRI COUNTY PRACTICE ASSOCIATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/01/2013
Last Update Date: 07/01/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

715 DISCOVERY BLVD SUITE 407
CEDAR PARK TX
78613-2287
US

IV. Provider business mailing address

3724 EXECUTIVE CENTER DR SUITE G-10
AUSTIN TX
78731-1646
US

V. Phone/Fax

Practice location:
  • Phone: 512-528-2300
  • Fax:
Mailing address:
  • Phone: 512-345-5925
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number
License Number State

VIII. Authorized Official

Name: LORI STALLINGS
Title or Position: DIRECTOR
Credential:
Phone: 512-324-8300