Basic Information
| Provider Information | |||||||||
| NPI: | 1407196314 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | TRI COUNTY PRACTICE ASSOCIATION | ||||||||
| LastName: | |||||||||
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| OtherOrganizationName: | SPINE AND REHABILITATION CENTER | ||||||||
| OtherOrganizationType: | 3 | ||||||||
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| Mailing Information | |||||||||
| Address1: | 3724 EXECUTIVE CENTER DR | ||||||||
| Address2: | SUITE G-10 | ||||||||
| City: | AUSTIN | ||||||||
| State: | TX | ||||||||
| PostalCode: | 787311646 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5123455925 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 715 DISCOVERY BLVD | ||||||||
| Address2: | SUITE 407 | ||||||||
| City: | CEDAR PARK | ||||||||
| State: | TX | ||||||||
| PostalCode: | 786132287 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5125282300 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 03/01/2013 | ||||||||
| LastUpdateDate: | 07/01/2013 | ||||||||
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| AuthorizedOfficialLastName: | STALLINGS | ||||||||
| AuthorizedOfficialFirstName: | LORI | ||||||||
| AuthorizedOfficialMiddleName: | |||||||||
| AuthorizedOfficialTitleorPosition: | DIRECTOR | ||||||||
| AuthorizedOfficialTelephone: | 5123248300 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 332B00000X | Y | Suppliers | Durable Medical Equipment & Medical Supplies |
No ID Information.