Provider Demographics
NPI:1649375452
Name:TRI COUNTY SURGERY CENTER LLC
Entity type:Organization
Organization Name:TRI COUNTY SURGERY CENTER LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT - OPHTHALMOLOGIST
Authorized Official - Prefix:DR
Authorized Official - First Name:RICHARD
Authorized Official - Middle Name:BLAIR
Authorized Official - Last Name:PRINCE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:215-396-4211
Mailing Address - Street 1:319 2ND STREET PIKE
Mailing Address - Street 2:
Mailing Address - City:SOUTHAMPTON
Mailing Address - State:PA
Mailing Address - Zip Code:18966-3812
Mailing Address - Country:US
Mailing Address - Phone:215-355-4428
Mailing Address - Fax:215-355-0790
Practice Address - Street 1:319 2ND STREET PIKE
Practice Address - Street 2:
Practice Address - City:SOUTHAMPTON
Practice Address - State:PA
Practice Address - Zip Code:18966-3812
Practice Address - Country:US
Practice Address - Phone:215-355-4428
Practice Address - Fax:215-355-0790
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-14
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA1763261QS0132X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QS0132XAmbulatory Health Care FacilitiesClinic/CenterOphthalmologic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA095362Medicare ID - Type Unspecified