# TRI STATE COMMUNITY CLINIC, LLC

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

## Provider details

- **NPI number:** 1104317346
- **Authorized official:** RONALD CHAD PERKINS MD (CMO)
- **Authorized official phone:** (888) 492-8722

## Contact information

- **Practice address:** 1033 E MT. PLEASANT RD., STE. D., EVANSVILLE, IN 47725
- **Practice address phone:** (888) 492-8722
- **Practice address fax:** (812) 491-0333
- **Mailing address:** 1033 E MT. PLEASANT RD., STE. D, EVANSVILLE, IN 47725
- **Mailing address phone:** (888) 492-8722
- **Mailing address fax:** (812) 491-0333

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 207Q00000X | Family Medicine Physician | — | NULL | Yes |
| 207Q00000X | Family Medicine Physician | — | — | Yes |

## Other

- **Enumeration date:** 05/23/2018
- **Last updated:** 05/23/2018