# TRI COUNTY MEDICAL LLC

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1194182188
- **Authorized official:** JAY KHAN (PRESIDENT)
- **Authorized official phone:** (262) 697-3668

## Contact information

- **Practice address:** 4310 W CRYSTAL LAKE RD, SUITE F, MCHENRY, IL 60050-4214
- **Practice address phone:** (815) 363-3223
- **Practice address fax:** (815) 363-3240
- **Mailing address:** 7611 PERSHING BLVD, KENOSHA, WI 53142-4317
- **Mailing address phone:** (262) 697-3668
- **Mailing address fax:** (262) 697-3500

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 261QA1903X | Ambulatory Surgical Clinic/Center | T059603 | WI | Yes |

## Other

- **Enumeration date:** 01/21/2016
- **Last updated:** 01/21/2016