Provider Demographics
NPI:1194287086
Name:TRI-COUNTY PRIMARY CARE LLC
Entity type:Organization
Organization Name:TRI-COUNTY PRIMARY CARE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:W
Authorized Official - Last Name:CAMPBELL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:580-857-1300
Mailing Address - Street 1:PO BOX 170
Mailing Address - Street 2:
Mailing Address - City:OZARK
Mailing Address - State:AR
Mailing Address - Zip Code:72949-0170
Mailing Address - Country:US
Mailing Address - Phone:866-243-7203
Mailing Address - Fax:833-243-7203
Practice Address - Street 1:200 N EASTON
Practice Address - Street 2:
Practice Address - City:ALLEN
Practice Address - State:OK
Practice Address - Zip Code:74825-9713
Practice Address - Country:US
Practice Address - Phone:580-857-1300
Practice Address - Fax:833-243-7203
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-04-01
Last Update Date:2019-04-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty