Provider Demographics
NPI:1316349236
Name:TRI-COUNTY NEUROLOGICAL ASSOCIATES
Entity type:Organization
Organization Name:TRI-COUNTY NEUROLOGICAL ASSOCIATES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN ASSISTANT
Authorized Official - Prefix:MRS
Authorized Official - First Name:NICHOLE
Authorized Official - Middle Name:
Authorized Official - Last Name:WORTHING
Authorized Official - Suffix:
Authorized Official - Credentials:PA-C
Authorized Official - Phone:586-286-2770
Mailing Address - Street 1:39581 GARFIELD RD
Mailing Address - Street 2:
Mailing Address - City:CLINTON TWP
Mailing Address - State:MI
Mailing Address - Zip Code:48038-4300
Mailing Address - Country:US
Mailing Address - Phone:586-286-2770
Mailing Address - Fax:586-286-9080
Practice Address - Street 1:39581 GARFIELD RD
Practice Address - Street 2:
Practice Address - City:CLINTON TWP
Practice Address - State:MI
Practice Address - Zip Code:48038-4300
Practice Address - Country:US
Practice Address - Phone:586-286-2770
Practice Address - Fax:586-286-9080
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-09-23
Last Update Date:2014-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5601005798363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedicalGroup - Single Specialty