NPIMap

Organization Active NPI

Tri County Medical LLC

  • Ambulatory Surgical Clinic/Center
  • McHenry, IL
National Provider Identifier
1194182188
Registry record updated Jan 21, 2016
On this page

Key facts

NPPES NPI Registry
Primary specialty
Ambulatory Surgical Clinic/CenterTaxonomy code 261QA1903X
License
T059603 Issued in WI
Legal business name
TRI COUNTY MEDICAL LLC
Practice address
4310 W Crystal Lake Rd
Suite F
McHenry, IL 60050-4214
Phone
(815) 363-3223
Fax
(815) 363-3240
NPI assigned
Jan 21, 2016
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jan 21, 2016

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Jay Khan
Title
President
Phone
(262) 697-3668

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Ambulatory Surgical Clinic/Center 261QA1903X T059603 WI Primary

Addresses

Primary practice location

4310 W Crystal Lake Rd
Suite F
McHenry, IL 60050-4214

Mailing address

7611 Pershing Blvd
Kenosha, WI 53142-4317
Phone (262) 697-3668

National Provider Directory

National Provider Directory
Tax ID family
Tri County Medical LLC2 organizations share this tax ID, including this one

Other organizations with this tax ID 1

Organizations that report the same tax identification number in the National Provider Directory.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1453334400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1453334400000",
    "number": "1194182188",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "7611 PERSHING BLVD",
            "city": "KENOSHA",
            "state": "WI",
            "postal_code": "531424317",
            "telephone_number": "262-697-3668",
            "fax_number": "262-697-3500"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4310 W CRYSTAL LAKE RD",
            "address_2": "SUITE F",
            "city": "MCHENRY",
            "state": "IL",
            "postal_code": "600504214",
            "telephone_number": "815-363-3223",
            "fax_number": "815-363-3240"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "TRI COUNTY MEDICAL LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2016-01-21",
        "last_updated": "2016-01-21",
        "status": "A",
        "authorized_official_last_name": "KHAN",
        "authorized_official_first_name": "JAY",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "262-697-3668"
    },
    "taxonomies": [
        {
            "code": "261QA1903X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Ambulatory Surgical",
            "state": "WI",
            "license": "T059603",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in McHenry, IL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 21, 2016; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.