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Organization

TRI STATE CLINIC, INC.

Active
Other names
Tri State Rural Health Clinic
Organization subpart
No

Provider details

NPI number
Authorized official
MRS. JANET STACY (ADMINISTRATOR)
(276) 935-8620
Entity
Organization

Contact information

Practice address
1520 SLATE CREEK RD, GRUNDY, VA 24614-6975
(276) 935-8620
(276) 935-4430
Mailing address
1520 SLATE CREEK RD, GRUNDY, VA 24614-6975
(276) 935-8620
(276) 935-4430

Taxonomy

Speciality
Code
Description
License number
State
261QR1300X
Rural Health Clinic/Center
Primary

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
0034714000
WV
05
007610262
VA
05
35000470
KY
Enumeration date
03/16/2006
Last updated
03/09/2010
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