Provider Demographics
NPI:1285771600
Name:TRI-CITY COLO-RECTAL SURGERY LTD
Entity type:Organization
Organization Name:TRI-CITY COLO-RECTAL SURGERY LTD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:KARUKURICHI
Authorized Official - Middle Name:S
Authorized Official - Last Name:VENKATESH
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:480-835-5302
Mailing Address - Street 1:2223 E BASELINE RD
Mailing Address - Street 2:SUITE A
Mailing Address - City:GILBERT
Mailing Address - State:AZ
Mailing Address - Zip Code:85234-2325
Mailing Address - Country:US
Mailing Address - Phone:480-835-5302
Mailing Address - Fax:480-844-2081
Practice Address - Street 1:2223 E BASELINE RD
Practice Address - Street 2:SUITE A
Practice Address - City:GILBERT
Practice Address - State:AZ
Practice Address - Zip Code:85234-2325
Practice Address - Country:US
Practice Address - Phone:480-835-5302
Practice Address - Fax:480-844-2081
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-01
Last Update Date:2024-08-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208C00000XAllopathic & Osteopathic PhysiciansColon & Rectal SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZZ6606Medicare ID - Type Unspecified