TRI STATE CLINIC, INC. (NPI# 1124097795) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1124097795 |
| Entity Type | Organization |
| Organization Name | TRI STATE CLINIC, INC. |
| Other Organization Name | TRI STATE RURAL HEALTH CLINIC |
| Practice Address |
1520 Slate Creek Rd Grundy VA 24614-6975 |
| Practice Telephone | 2769358620 |
| Practice Fax Number | 2769354430 |
| Mailing Telephone | 2769358620 |
| Mailing Fax Number | 2769354430 |
| Enumeration Date | 2006-03-16 |
| Last Update Date | 2010-03-09 |
| Authorized Official Name | MRS. JANET STACY (ADMINISTRATOR) |
| Authorized Official Telephone | 2769358620 |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 261QR1300X |
Clinic/Center Specialization: Rural Health |
Ambulatory Health Care Facilities |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| VA | 007610262 | 05 | |
| WV | 0034714000 | 05 | |
| KY | 35000470 | 05 |
| Other Name | Type Code |
|---|---|
| Tri State Rural Health Clinic | Doing Business As Name - Organization |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1518083971 | Tri State Clinic, Inc. | Pediatrics | 1520 Slate Creek Rd, Grundy, VA 24614-6975 | 2007-03-21 |
| Street Address |
1520 SLATE CREEK RD |
| City | GRUNDY |
| State | VA |
| Zip Code | 24614-6975 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1043635279 | Buchanan Pharmacy Associates | Pharmacy | 1520 Slate Creek Rd, Grundy, VA 24614-6975 | 2014-02-25 |
| 1841501855 | Trishia Gail Hagerman-payne | Physician Assistant | 1520 Slate Creek Rd, Grundy, VA 24614-6975 | 2010-06-24 |
| 1841426996 | Pikeville Medical Center, Inc. | Clinic/Center | 1520 Slate Creek Rd, Grundy, VA 24614-6975 | 2009-06-03 |
| 1518083971 | Tri State Clinic, Inc. | Pediatrics | 1520 Slate Creek Rd, Grundy, VA 24614-6975 | 2007-03-21 |
| 1922049212 | Jashubhai G Patel | Internal Medicine | 1520 Slate Creek Rd, Grundy, VA 24614-6975 | 2006-06-09 |
| 1801857743 | Jashbhai N Patel | Surgery | 1520 Slate Creek Rd, Suite 101, Grundy, VA 24614-6975 | 2006-03-30 |
| 1245209402 | Haresh J Patel | Internal Medicine | 1520 Slate Creek Rd, Grundy, VA 24614-6975 | 2006-03-17 |
| 1831168004 | Dinkar N Patel | Internal Medicine | 1520 Slate Creek Rd, Grundy, VA 24614-6975 | 2006-03-17 |
| 1609845874 | Rajnikant R Patel | Pediatrics | 1520 Slate Creek Rd, Grundy, VA 24614-6975 | 2006-03-17 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1861962425 | Leah Jessee | Nurse Practitioner | 1107 Riverview Street, Grundy, VA 24614 | 2018-11-27 |
| 1467989137 | Amanda Fletcher | Nurse Practitioner | 1298 Lick Log Road, Grundy, VA 24614 | 2017-05-12 |
| 1578800967 | Coetta Lynn Neece | Nurse Practitioner | 18334 Riverside Drive, Grundy, VA 24614 | 2013-01-07 |
| 1376894840 | Tina Michele Williams | Nurse Practitioner | 1520 Slate Creek Rd Suite 205, Grundy, VIRGINIA 24614 | 2012-09-25 |
| 1881980647 | Ngd Incorporated | Pharmacy | 1063 Edgewater Dr., Grundy, VA 24614 | 2011-06-21 |
| 1710291216 | Pamela D Harrison | Nurse Practitioner | 28567 Riverside Drive, Grundy, VA 24614 | 2010-07-27 |
| 1477889111 | Susan Buskill Fogg | Counselor | 19873 Riverside Drive, Grundy, VA 24614 | 2009-10-31 |
| 1336396043 | Maranda Gayle Fletcher-meadows | Speech-Language Pathologist | 5820 Slate Creek Road, Grundy, VA 24614 | 2008-08-25 |
| 1528282241 | Joshua P Sutherland Jr PC | Family Medicine | 20886 Riverside Drive, Grundy, VA 24614 | 2007-04-12 |
| 1043339989 | Grundy Internal Medicine, PC | Internal Medicine | 1532 Slate Creek Road, Ste 203, Grundy, VA 24614 | 2007-03-29 |
| Find all providers in zip 24614 | ||||
| Taxonomy Code | 261QR1300X |
| Grouping | Ambulatory Health Care Facilities |
| Classification | Clinic/Center |
| Specialization | Rural Health |
| Definition to come... |
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| 1457840183 | Warren Memorial Hospital, Inc. | Clinic/Center | 315 W 10th St Ste 1, Front Royal, VA 22630-2812 | 2018-05-08 |
| 1154857019 | Bath County Community Hospital | Clinic/Center | 713 S Monroe Ave, Covington, VA 24426-1832 | 2017-05-11 |
| 1891154019 | Appalachian Regional Healthcare, Inc. | Clinic/Center | 121 Stacy Dr, Pennington Gap, VA 24277-1929 | 2016-02-16 |
| 1366791972 | Free Clinic of Franklin County | Clinic/Center | 1171 Franklin Street, Rocky Mount, VA 24151 | 2012-08-29 |
| 1487818902 | St. Mary's Health Wagon | Clinic/Center | 233 Chase St., Clintwood, VA 24228 | 2008-07-14 |
| 1609054733 | Mountain States Health Alliance | Clinic/Center | 16431 Wise Street, Saint Paul, VA 24283-3537 | 2008-01-31 |
| 1013199322 | Page Memorial Hospital, Inc. | Clinic/Center | 505 Williams Ave, Shenandoah, VA 22849-1263 | 2007-11-28 |
| Find all providers with the same taxonomy | ||||
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.