Provider Demographics
NPI:1124688411
Name:TRI COUNTY MEDICAL CENTER LLC
Entity type:Organization
Organization Name:TRI COUNTY MEDICAL CENTER LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:ERNEST
Authorized Official - Middle Name:
Authorized Official - Last Name:SCRIVEN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:352-302-0756
Mailing Address - Street 1:155 SE US HIGHWAY 19
Mailing Address - Street 2:
Mailing Address - City:CRYSTAL RIVER
Mailing Address - State:FL
Mailing Address - Zip Code:34429-4838
Mailing Address - Country:US
Mailing Address - Phone:352-228-4938
Mailing Address - Fax:352-228-8041
Practice Address - Street 1:155 SE US HIGHWAY 19
Practice Address - Street 2:
Practice Address - City:CRYSTAL RIVER
Practice Address - State:FL
Practice Address - Zip Code:34429-4838
Practice Address - Country:US
Practice Address - Phone:352-228-4938
Practice Address - Fax:352-228-8041
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-06-18
Last Update Date:2019-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty