Organization
TRI-STATE COMMUNITY HEALTH CENTER, INC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
SATRICIA A WOODAL (HR MANAGER)
(301) 678-5187
Entity
Organization
Contact information
Practice address
621 KELLY RD, CUMBERLAND, MD 21502-2878
(301) 722-3270
(301) 678-3276
Mailing address
109 RAYLOC DR, HANCOCK, MD 21750-1518
(301) 678-5187
(301) 678-5797
Taxonomy
Speciality
Code
Description
License number
State
363LF0000X
Family Nurse Practitioner
Primary
R200178
MD
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
211828
MEDICARE FQHC
MD
Enumeration date
10/16/2013
Last updated
10/16/2013
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