Basic Information
| Provider Information | |||||||||
| NPI: | 1790732857 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | TRI CITY MEDICAL ASSOCIATES PC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 10777 W TWAIN AVENUE | ||||||||
| Address2: | SUITE 225 | ||||||||
| City: | LAS VEGAS | ||||||||
| State: | NV | ||||||||
| PostalCode: | 89135 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7028390946 | ||||||||
| FaxNumber: | 7028390149 | ||||||||
| Practice Location | |||||||||
| Address1: | 10777 W TWAIN AVENUE | ||||||||
| Address2: | SUITE 225 | ||||||||
| City: | LAS VEGAS | ||||||||
| State: | NV | ||||||||
| PostalCode: | 89135 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7028390946 | ||||||||
| FaxNumber: | 7028390149 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/27/2006 | ||||||||
| LastUpdateDate: | 08/22/2020 | ||||||||
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| AuthorizedOfficialLastName: | SWENSON | ||||||||
| AuthorizedOfficialFirstName: | DARREN | ||||||||
| AuthorizedOfficialMiddleName: | RANDOLPH | ||||||||
| AuthorizedOfficialTitleorPosition: | PRESIDENT | ||||||||
| AuthorizedOfficialTelephone: | 7028390946 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | DR. | ||||||||
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| AuthorizedOfficialCredential: | M.D. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207R00000X | 11397 | NV | Y | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Internal Medicine |
No ID Information.