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Organization
TRI-STATE FAMILYCARE, INC
Active
Organization
TRI-STATE FAMILYCARE, INC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
LARRY ROARL APRN (PRESIDENT/OWNER)
(606) 242-3100
Entity
Organization
Contact information
Practice address
2317 CUMBERLAND AVE, MIDDLESBORO, KY 40965-2834
(606) 242-3100
Mailing address
2317 CUMBERLAND AVE, MIDDLESBORO, KY 40965-2834
(606) 242-3100
Taxonomy
Speciality
Code
Description
License number
State
363LF0000X
Family Nurse Practitioner
Primary
3011074
KY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1437281649
NPI
—
Enumeration date
03/01/2017
Last updated
03/01/2017
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