MEDICARE: TRI COUNTY ANESTHESIA ASSOCIATES, PC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	367500000X	Certified Registered Nurse Anesthetist
2	207L00000X	Anesthesiology Physician

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1073571485
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	TRI COUNTY ANESTHESIA ASSOCIATES, PC

Provider Business Mailing Address
First Line	:	3501 MASONS MILL RD
Second Line	:	SUITE 501
City	:	HUNTINGDON VALLEY
State	:	PA
Zip	:	19006-3517
Country	:	US
Telephone Number	:	215-830-0530
Fax Number	:	215-830-0542

Provider Business Practice Location Address
First Line	:	3501 MASONS MILL RD
Second Line	:	SUITE 501
City	:	HUNTINGDON VALLEY
State	:	PA
Zip	:	19006-3517
Country	:	US
Telephone Number	:	215-830-0530
Fax Number	:	215-830-0542

Authorized Official
Title or Position	:	CEO
Name	:	DR. JAY M MERGAMAN
Credential	:	M.D.
Telephone Number	:	215-773-9514

Provider Enumeration Date	:	05/03/2006
Last Update Date	:	03/08/2012

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