Provider Demographics
NPI:1366403792
Name:TRI-COUNTY PEDIATRICS LLC
Entity type:Organization
Organization Name:TRI-COUNTY PEDIATRICS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGING PHYSICIAN
Authorized Official - Prefix:
Authorized Official - First Name:GAURANG
Authorized Official - Middle Name:C
Authorized Official - Last Name:SHAH
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:803-329-2700
Mailing Address - Street 1:165 AMENDMENT AVENUE
Mailing Address - Street 2:SUITE 102
Mailing Address - City:ROCK HILL
Mailing Address - State:SC
Mailing Address - Zip Code:29732-2730
Mailing Address - Country:US
Mailing Address - Phone:803-329-2700
Mailing Address - Fax:803-329-2788
Practice Address - Street 1:165 AMENDMENT AVE
Practice Address - Street 2:SUITE 102
Practice Address - City:ROCK HILL
Practice Address - State:SC
Practice Address - Zip Code:29732-3036
Practice Address - Country:US
Practice Address - Phone:803-329-2700
Practice Address - Fax:803-329-2788
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-03-28
Last Update Date:2021-03-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC22018208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
SC27567Medicare UPIN