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Organization
TRI STATE FAMILY MEDICAL CENTER, LLC
Active
Organization
TRI STATE FAMILY MEDICAL CENTER, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. JANICE GAUZE (VICE PRESIDENT)
(606) 638-3131
Entity
Organization
Contact information
Practice address
2583 HIGHWAY 644 STE 1, LOUISA, KY 41230-9436
(606) 638-3131
(606) 638-3139
Mailing address
2583 HIGHWAY 644 STE 1, LOUISA, KY 41230-9436
(606) 638-3131
(606) 638-3139
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
25469
KY
261QP2300X
Primary Care Clinic/Center
25469
KY
261QU0200X
Urgent Care Clinic/Center
25469
NULL
363LF0000X
Family Nurse Practitioner
3007167
KY
Other
Enumeration date
05/14/2009
Last updated
12/09/2014
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