Provider Demographics
NPI:1174568893
Name:TRI-MEDICAL LLC
Entity type:Organization
Organization Name:TRI-MEDICAL LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:VP
Authorized Official - Prefix:
Authorized Official - First Name:CAROL
Authorized Official - Middle Name:
Authorized Official - Last Name:SMITH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:540-633-2512
Mailing Address - Street 1:7350 PEPPERS FERRY BLVD
Mailing Address - Street 2:
Mailing Address - City:FAIRLAWN
Mailing Address - State:VA
Mailing Address - Zip Code:24141-8856
Mailing Address - Country:US
Mailing Address - Phone:540-633-2512
Mailing Address - Fax:
Practice Address - Street 1:7350 PEPPERS FERRY BLVD
Practice Address - Street 2:
Practice Address - City:FAIRLAWN
Practice Address - State:VA
Practice Address - Zip Code:24141-8856
Practice Address - Country:US
Practice Address - Phone:540-633-2512
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-17
Last Update Date:2008-01-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA1174568893Medicaid
DC0032Medicare PIN
VAC09078Medicare PIN