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General NPI Number Information
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NPI Number | 1760495923
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Entity Type | Organization
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Legal Business Name | TRICOUNTY SURGICAL ASSOCIATES, PA
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Dates
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Enumeration Date | 08/15/2006
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Last Update Date | 08/05/2010
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Provider Practice Location Address
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Address Line | 9239 MEDICAL PLAZA DR
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City | CHARLESTON
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State | SC
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Zip | 29406-9126
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Country | US
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Telephone | 843-797-5151
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Fax | 843-572-6939
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Provider Business Mailing Address
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Address Line | 9239 MEDICAL PLAZA DR
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City | CHARLESTON
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State | SC
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Zip | 29406-9126
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Country | US
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Telephone | 843-797-5151
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Fax | 843-572-6939
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Authorized Official
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Title or Position | BILLING SUPERVISOR
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Name | JANICE TRUDEAU
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Credential |
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Telephone | 843-797-5157
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208600000X
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Taxonomy Name | Surgery Physician
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License Number |
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License Number State |
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