Basic Information
| Provider Information | |||||||||
| NPI: | 1356557631 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | TRI-COUNTY EMERGENCY PHYSICIANS PC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 17717 MASONIC BLVD | ||||||||
| Address2: | |||||||||
| City: | FRASER | ||||||||
| State: | MI | ||||||||
| PostalCode: | 480263158 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5862942700 | ||||||||
| FaxNumber: | 5862942525 | ||||||||
| Practice Location | |||||||||
| Address1: | 826 W KING ST | ||||||||
| Address2: | |||||||||
| City: | OWOSSO | ||||||||
| State: | MI | ||||||||
| PostalCode: | 488672120 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5174875585 | ||||||||
| FaxNumber: | 5174871129 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/15/2007 | ||||||||
| LastUpdateDate: | 06/21/2018 | ||||||||
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| AuthorizedOfficialLastName: | BUSTAMANTE | ||||||||
| AuthorizedOfficialFirstName: | JOSEPH | ||||||||
| AuthorizedOfficialMiddleName: | M | ||||||||
| AuthorizedOfficialTitleorPosition: | PRESIDENT | ||||||||
| AuthorizedOfficialTelephone: | 5862942700 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNameSuffix: | III | ||||||||
| AuthorizedOfficialCredential: | DO | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207P00000X | Y | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Emergency Medicine |
No ID Information.