Organization
TRICORNE PRIMARY NERVE & JOINT, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. EARL W EDWARDS M.D. (SOLE MEMBER)
(717) 747-3220
Entity
Organization
Contact information
Practice address
2200 S GEORGE ST, SUITE W-2, YORK, PA 17403-4594
(717) 747-3220
(717) 747-3338
Mailing address
2200 S GEORGE ST, SUITE W-2, YORK, PA 17403-4594
(717) 747-3220
(717) 747-3338
Taxonomy
Speciality
Code
Description
License number
State
261QH0100X
Health Service Clinic/Center
MD427825
PA
261QM1300X
Multi-Specialty Clinic/Center
MD427825
PA
261QP2300X
Primary Care Clinic/Center
Primary
MD427825
PA
261QP3300X
Pain Clinic/Center
BE8901060
PA
302R00000X
Health Maintenance Organization
MD427825
PA
305R00000X
Preferred Provider Organization
MD427825
PA
305S00000X
Point of Service
MD427825
PA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0090250
MEDICARE ID
PA
Enumeration date
08/18/2014
Last updated
01/20/2016
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