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
—
363LF0000X
Family Nurse Practitioner
3007167
KY
Other
Enumeration date
05/14/2009
Last updated
12/09/2014
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