Organization
TRI-STATE COMMUNITY HEALTH CENTER-HOSP PHYSICIANS PRACTICE
Active
Other names
TRI-STATE WOMEN'S HEALTH CENTER - HOSP PHYSICIAN PRACTICE
Organization subpart
No
Provider details
NPI number
Authorized official
SHEILA J DESHONG (CHEIF OPERATING OFFICER)
(301) 678-5187
Entity
Organization
Contact information
Practice address
12502 WILLOWBROOK RD, SUITE 550, 5TH FLR, CUMBERLAND, MD 21502-6491
(301) 723-3940
(301) 723-3941
Mailing address
109 RAYLOC DR, HANCOCK, MD 21750-1518
(301) 678-5187
(301) 678-5797
Taxonomy
Speciality
Code
Description
License number
State
261QF0400X
Federally Qualified Health Center (FQHC)
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
211849
MEDICARE FQHC
MD
Enumeration date
11/08/2013
Last updated
11/08/2013
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