Provider Demographics
NPI:1588731756
Name:TRI CARE PC
Entity type:Organization
Organization Name:TRI CARE PC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:PHIA
Authorized Official - Middle Name:
Authorized Official - Last Name:PARHAM
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:248-559-8190
Mailing Address - Street 1:31800 NORTHWESTERN HWY
Mailing Address - Street 2:SUITE 120
Mailing Address - City:FARMINGTON HILLS
Mailing Address - State:MI
Mailing Address - Zip Code:48334-1663
Mailing Address - Country:US
Mailing Address - Phone:248-559-8190
Mailing Address - Fax:248-702-6704
Practice Address - Street 1:31800 NORTHWESTERN HWY
Practice Address - Street 2:SUITE 120
Practice Address - City:FARMINGTON HILLS
Practice Address - State:MI
Practice Address - Zip Code:48334-1663
Practice Address - Country:US
Practice Address - Phone:248-559-8190
Practice Address - Fax:248-702-6704
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-30
Last Update Date:2014-10-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI104100000X, 103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologistGroup - Multi-Specialty
No104100000XBehavioral Health & Social Service ProvidersSocial WorkerGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI0N90430Medicare PIN
MI0N90420Medicare PIN
MI0P01320Medicare PIN