Organization
TRI-RIVERS HEALTHCARE PLLC
Active
Other names
Salem Medical Clinic
Organization subpart
No
Provider details
NPI number
Authorized official
MR. MICHAEL ALBIN HENEISEN (AGENT)
(270) 988-3298
Entity
Organization
Contact information
Practice address
141 HOSPITAL DR, SALEM, KY 42078-8043
(270) 988-3298
(270) 988-4642
Mailing address
PO BOX 347, SALEM, KY 42078-0347
(270) 988-3298
(270) 988-4642
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
—
—
208600000X
Surgery Physician
—
—
208D00000X
General Practice Physician
—
—
261QR1300X
Rural Health Clinic/Center
Primary
900216
KY
363AM0700X
Medical Physician Assistant
—
—
363LF0000X
Family Nurse Practitioner
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
6590103500
—
KY
05
—
7100091640
—
KY
05
—
7890094100
—
KY
Enumeration date
01/18/2006
Last updated
07/12/2016
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