Basic Information
| Provider Information | |||||||||
| NPI: | 1861552341 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | TRI COUNTY MEDICAL ASSOCIATES PC | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 759 | ||||||||
| Address2: | |||||||||
| City: | VALLEY | ||||||||
| State: | AL | ||||||||
| PostalCode: | 368540759 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7066431073 | ||||||||
| FaxNumber: | 7066431070 | ||||||||
| Practice Location | |||||||||
| Address1: | 2 48TH ST | ||||||||
| Address2: | |||||||||
| City: | VALLEY | ||||||||
| State: | AL | ||||||||
| PostalCode: | 368543615 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3347562136 | ||||||||
| FaxNumber: | 3347564184 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 12/12/2006 | ||||||||
| LastUpdateDate: | 08/01/2008 | ||||||||
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| AuthorizedOfficialLastName: | SHIVER | ||||||||
| AuthorizedOfficialFirstName: | MAX | ||||||||
| AuthorizedOfficialMiddleName: | RONALD | ||||||||
| AuthorizedOfficialTitleorPosition: | CEO | ||||||||
| AuthorizedOfficialTelephone: | 7066431073 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | DR. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 174400000X | Y | 193200000X MULTI-SPECIALTY GROUP | Other Service Providers | Specialist |
No ID Information.