Organization
TRI-STATE MEDICAL MANAGEMENT
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. KELLY DIANNE CASSRIEL (PRESIDENT)
(901) 857-1150
Entity
Organization
Contact information
Practice address
2832 COLEMAN RD, MEMPHIS, TN 38128-5815
(901) 857-1150
Mailing address
2832 COLEMAN RD, MEMPHIS, TN 38128-5815
(901) 857-1150
Taxonomy
Speciality
Code
Description
License number
State
291U00000X
Clinical Medical Laboratory
115004107
TN
302R00000X
Health Maintenance Organization
Primary
210506056
TN
Other
Enumeration date
11/12/2015
Last updated
11/12/2015
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