Provider Demographics
NPI:1669619169
Name:TRI-COUNTY PULMONARY & MULTI-SPECIALTY GROUP
Entity type:Organization
Organization Name:TRI-COUNTY PULMONARY & MULTI-SPECIALTY GROUP
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:BUSINESS ADMINISTRATOR
Authorized Official - Prefix:MR
Authorized Official - First Name:DAN
Authorized Official - Middle Name:
Authorized Official - Last Name:ARSENIJEVITH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:352-350-1556
Mailing Address - Street 1:1507 BUENOS AIRES BLVD
Mailing Address - Street 2:
Mailing Address - City:THE VILLAGES
Mailing Address - State:FL
Mailing Address - Zip Code:32159-8974
Mailing Address - Country:US
Mailing Address - Phone:352-350-1600
Mailing Address - Fax:352-750-8026
Practice Address - Street 1:3365 WEDGEWOOD LN
Practice Address - Street 2:
Practice Address - City:THE VILLAGES
Practice Address - State:FL
Practice Address - Zip Code:32162-7181
Practice Address - Country:US
Practice Address - Phone:352-350-1600
Practice Address - Fax:352-750-8026
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:TRI-COUNTY PULMONARY & MULTI-SPECIALTY GROUP
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2009-01-21
Last Update Date:2009-01-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary DiseaseGroup - Multi-Specialty