Provider Demographics
NPI:1861552341
Name:TRI COUNTY MEDICAL ASSOCIATES PC
Entity type:Organization
Organization Name:TRI COUNTY MEDICAL ASSOCIATES PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:MAX
Authorized Official - Middle Name:RONALD
Authorized Official - Last Name:SHIVER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:706-643-1073
Mailing Address - Street 1:PO BOX 759
Mailing Address - Street 2:
Mailing Address - City:VALLEY
Mailing Address - State:AL
Mailing Address - Zip Code:36854-0759
Mailing Address - Country:US
Mailing Address - Phone:706-643-1073
Mailing Address - Fax:706-643-1070
Practice Address - Street 1:2 48TH ST
Practice Address - Street 2:
Practice Address - City:VALLEY
Practice Address - State:AL
Practice Address - Zip Code:36854-3615
Practice Address - Country:US
Practice Address - Phone:334-756-2136
Practice Address - Fax:334-756-4184
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-12
Last Update Date:2008-08-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Multi-Specialty