Provider Demographics
NPI:1366776098
Name:TRI COUNTY IPA, INC
Entity type:Organization
Organization Name:TRI COUNTY IPA, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:
Authorized Official - Last Name:ABELLARD
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:561-433-4446
Mailing Address - Street 1:4849 LAKE WORTH RD
Mailing Address - Street 2:
Mailing Address - City:GREENACRES
Mailing Address - State:FL
Mailing Address - Zip Code:33463-3455
Mailing Address - Country:US
Mailing Address - Phone:561-433-4446
Mailing Address - Fax:561-433-3026
Practice Address - Street 1:4849 LAKE WORTH RD
Practice Address - Street 2:
Practice Address - City:GREENACRES
Practice Address - State:FL
Practice Address - Zip Code:33463-3455
Practice Address - Country:US
Practice Address - Phone:561-433-4446
Practice Address - Fax:561-433-3026
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-09-29
Last Update Date:2009-09-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes302R00000XManaged Care OrganizationsHealth Maintenance Organization
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL=========OtherTAX ID