Organization
TRI STATE MEDICAL CLINIC INC
Active
Organization
TRI STATE MEDICAL CLINIC INC
Active
Other names
Tri-State Family Healthcare
Organization subpart
No
Provider details
NPI number
Authorized official
LARRY B ROARK NP-C (NURSE PRACTITIONER/OWNER)
(606) 242-3100
Entity
Organization
Contact information
Practice address
3503 CUMBERLAND AVE, MIDDLESBORO, KY 40965-2611
(606) 242-3100
(606) 242-3984
Mailing address
PO BOX 217, MIDDLESBORO, KY 40965-0217
(606) 242-3100
(606) 242-3984
Taxonomy
Speciality
Code
Description
License number
State
261QR1300X
Rural Health Clinic/Center
Primary
—
—
363LF0000X
Family Nurse Practitioner
—
—
Other
Enumeration date
09/25/2006
Last updated
01/31/2020
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