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General NPI Number Information
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NPI Number | 1093844060
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Entity Type | Organization
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Legal Business Name | TRI COUNTY MEDICAL CENTER, INC
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Dates
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Enumeration Date | 03/05/2007
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Last Update Date | 02/12/2008
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Provider Practice Location Address
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Address Line | 1115 AZALEA PL
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City | BREWTON
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State | AL
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Zip | 36426-1318
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Country | US
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Telephone | 251-809-3925
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Fax | 251-809-6058
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Provider Business Mailing Address
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Address Line | PO BOX 726
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City | EVERGREEN
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State | AL
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Zip | 36401-0726
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Country | US
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Telephone | 251-578-1163
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Fax | 251-578-6963
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Authorized Official
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Title or Position | EXECUTIVE DIRECTOR
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Name | MARILYN J SAWYER
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Credential |
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Telephone | 251-578-1163
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QD0000X
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Taxonomy Name | Dental Clinic/Center
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License Number |
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License Number State |
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