Provider Demographics
NPI:1730268541
Name:TRI-COUNTY FAMILY MEDICINE ASSO PC
Entity type:Organization
Organization Name:TRI-COUNTY FAMILY MEDICINE ASSO PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATIVE SECRETARY
Authorized Official - Prefix:MRS
Authorized Official - First Name:MELISSA
Authorized Official - Middle Name:A
Authorized Official - Last Name:PRITCHARD
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:716-241-7067
Mailing Address - Street 1:1 SCHOOL ST
Mailing Address - Street 2:SUITE 107
Mailing Address - City:GOWANDA
Mailing Address - State:NY
Mailing Address - Zip Code:14070-1133
Mailing Address - Country:US
Mailing Address - Phone:716-241-7067
Mailing Address - Fax:716-241-7197
Practice Address - Street 1:1 SCHOOL ST
Practice Address - Street 2:SUITE 107
Practice Address - City:GOWANDA
Practice Address - State:NY
Practice Address - Zip Code:14070-1133
Practice Address - Country:US
Practice Address - Phone:716-241-7067
Practice Address - Fax:716-241-7197
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-03
Last Update Date:2017-04-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01213345Medicaid
J400262138Medicare PIN
11512CMedicare PIN
PA0806Medicare PIN
11512AMedicare PIN
J4003389521Medicare PIN
11512EMedicare PIN