Tri County Medical Associates PA

Primary specialty

Family Medicine PhysicianTaxonomy code 207Q00000X

Legal business name

TRI COUNTY MEDICAL ASSOCIATES PA

Practice address

820 Deltona Blvd
Suite a
Deltona, FL 32725-7177

Phone

(386) 860-4545

Fax

(386) 860-5632

NPI assigned

Feb 21, 2007

Organization subpart

No

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

Authorized official

Name

Dr. Pamela Pearson Hall, M.D.

Title

Vice President

Phone

(386) 860-4545

Specialties & licenses 1

Addresses

Other identifiers 2

Other names 1

• Deltona Fountains Medical Clinic Doing business as

Locations

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

{
    "created_epoch": "1172016000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1219017600000",
    "number": "1831234160",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "820 DELTONA BLVD",
            "address_2": "SUITE A",
            "city": "DELTONA",
            "state": "FL",
            "postal_code": "327257177",
            "telephone_number": "386-860-4545",
            "fax_number": "386-860-5632"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "820 DELTONA BLVD",
            "address_2": "SUITE A",
            "city": "DELTONA",
            "state": "FL",
            "postal_code": "327257177",
            "telephone_number": "386-860-4545",
            "fax_number": "386-860-5632"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "TRI COUNTY MEDICAL ASSOCIATES PA",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-02-21",
        "last_updated": "2008-08-18",
        "status": "A",
        "authorized_official_last_name": "HALL",
        "authorized_official_first_name": "PAMELA",
        "authorized_official_middle_name": "PEARSON",
        "authorized_official_title_or_position": "VICE PRESIDENT",
        "authorized_official_telephone_number": "386-860-4545",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Family Medicine",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "377330200",
            "state": "FL"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "PALMETTO GBA GROUP NUMBER",
            "identifier": "CA7444",
            "state": null
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Deltona Fountains Medical Clinic",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

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• Family Medicine Physician in Deltona, FL
• Providers in Deltona, FL by specialty
• Family Medicine Physician in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 18, 2008; 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.