Provider Demographics
NPI:1124294434
Name:TRI-COUNTY HEALTH SYSTEM, INC.
Entity type:Organization
Organization Name:TRI-COUNTY HEALTH SYSTEM, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:DONNA
Authorized Official - Middle Name:
Authorized Official - Last Name:NEWSOME
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:706-465-3253
Mailing Address - Street 1:PO BOX 312
Mailing Address - Street 2:
Mailing Address - City:WARRENTON
Mailing Address - State:GA
Mailing Address - Zip Code:30828-0312
Mailing Address - Country:US
Mailing Address - Phone:706-465-3253
Mailing Address - Fax:706-465-3028
Practice Address - Street 1:156 ALEXANDER STREET
Practice Address - Street 2:
Practice Address - City:CRAWFORDVILLE
Practice Address - State:GA
Practice Address - Zip Code:30631-2800
Practice Address - Country:US
Practice Address - Phone:706-456-2925
Practice Address - Fax:706-456-2224
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-05-06
Last Update Date:2008-06-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QF0400XAmbulatory Health Care FacilitiesClinic/CenterFederally Qualified Health Center (FQHC)
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA000215982EOtherMEDICAID FFS
GA08BBSCLOtherMEDICARE FFS
GA08BDFLSOtherMEDICARE FFS
GA000302068KOtherMEDICAID FFS
GA000471809COtherMEDICAID FQHC
GA08BDMNGOtherMEDICARE FFS
GA000308228COtherMEDICAID FFS
GA000060387TOtherMEDICAID FFS
GA08BDFZDOtherMEDICARE FFS
GA980939645GOtherMEDICAID FFS
GAGRP1619OtherMEDICARE FFS
GA08BBWTQOtherMEDICARE FFS
GAD46168Medicare UPIN
GAI33394Medicare UPIN
GAD46411Medicare UPIN
GAD46114Medicare UPIN
GA980939645GOtherMEDICAID FFS
GA08BDFLSOtherMEDICARE FFS