# TRI STATE FAMILY MEDICAL CENTER, LLC

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

## Provider details

- **NPI number:** 1194959452
- **Authorized official:** MRS. JANICE GAUZE (VICE PRESIDENT)
- **Authorized official phone:** (606) 638-3131

## Contact information

- **Practice address:** 2583 HIGHWAY 644 STE 1, LOUISA, KY 41230-9436
- **Practice address phone:** (606) 638-3131
- **Practice address fax:** (606) 638-3139
- **Mailing address:** 2583 HIGHWAY 644 STE 1, LOUISA, KY 41230-9436
- **Mailing address phone:** (606) 638-3131
- **Mailing address fax:** (606) 638-3139

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 207Q00000X | Family Medicine Physician | 25469 | KY | Yes |
| 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