Provider Demographics
NPI:1548369796
Name:TRI CITY SURGICAL ASSOCIATES
Entity type:Organization
Organization Name:TRI CITY SURGICAL ASSOCIATES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE PRACTICE ASSISTANT
Authorized Official - Prefix:MRS
Authorized Official - First Name:ELIZABETH
Authorized Official - Middle Name:M
Authorized Official - Last Name:FORD
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:804-524-2294
Mailing Address - Street 1:930 SOUTH AVE
Mailing Address - Street 2:SUITE 4 A
Mailing Address - City:COLONIAL HEIGHTS
Mailing Address - State:VA
Mailing Address - Zip Code:23834-3621
Mailing Address - Country:US
Mailing Address - Phone:804-524-2294
Mailing Address - Fax:804-524-0016
Practice Address - Street 1:930 SOUTH AVE
Practice Address - Street 2:SUITE 4 A
Practice Address - City:COLONIAL HEIGHTS
Practice Address - State:VA
Practice Address - Zip Code:23834-3621
Practice Address - Country:US
Practice Address - Phone:804-524-2294
Practice Address - Fax:804-524-0016
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-22
Last Update Date:2016-06-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA007385382Medicaid
027707OtherANTHEM BCBS
051145OtherANTHEM BCBS
VA007301201Medicaid
VA007305826Medicaid
110950OtherANTHEM BCBS
020013900Medicare PIN
051145OtherANTHEM BCBS
VAD73282Medicare UPIN
020000204Medicare PIN
VAE04355Medicare UPIN
VA007305826Medicaid
020013901Medicare PIN
110950OtherANTHEM BCBS
VAD73310Medicare UPIN
VA007385382Medicaid
VAE04355Medicare UPIN
VA007385382Medicaid