TRI-RIVERS HEALTHCARE PLLC (NPI# 1588644496) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1588644496 |
| Entity Type | Organization |
| Organization Name | TRI-RIVERS HEALTHCARE PLLC |
| Other Organization Name | SALEM MEDICAL CLINIC |
| Practice Address |
141 Hospital Dr Salem KY 42078-8043 |
| Mailing Address |
Po Box 347 Salem KY 42078-0347 |
| Practice Telephone | 2709883298 |
| Practice Fax Number | 2709884642 |
| Mailing Telephone | 2709883298 |
| Mailing Fax Number | 2709884642 |
| Enumeration Date | 2006-01-18 |
| Last Update Date | 2016-07-12 |
| Authorized Official Name | MR. MICHAEL ALBIN HENEISEN (AGENT) |
| Authorized Official Telephone | 2709883298 |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| N | 363AM0700X |
Physician Assistant Specialization: Medical |
Physician Assistants & Advanced Practice Nursing Providers | ||
| N | 363LF0000X |
Nurse Practitioner Specialization: Family |
Physician Assistants & Advanced Practice Nursing Providers | ||
| N | 207R00000X | Internal Medicine | Allopathic & Osteopathic Physicians | ||
| N | 208D00000X | General Practice | Allopathic & Osteopathic Physicians | ||
| N | 208600000X | Surgery | Allopathic & Osteopathic Physicians | ||
| Y | 261QR1300X |
Clinic/Center Specialization: Rural Health |
900216 | KY | Ambulatory Health Care Facilities |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| KY | 7890094100 | 05 | |
| KY | 6590103500 | 05 | |
| KY | 7100091640 | 05 |
| Other Name | Type Code |
|---|---|
| Salem Medical Clinic | Doing Business As Name - Organization |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1699895003 | Tri-rivers Healthcare Pllc | Internal Medicine | 308 S Main St, Marion, KY 42064-1545 | 2007-03-30 |
| 1598885998 | Tri-rivers Healthcare Pllc | Family Medicine | 205 E Adair St, Smithland, KY 42081-9507 | 2007-03-30 |
| Street Address |
141 HOSPITAL DR |
| City | SALEM |
| State | KY |
| Zip Code | 42078-8043 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1730184730 | Demetrius L Patton | Specialist | 141 Hospital Dr, Salem, KY 42078-8043 | 2005-06-16 |
| 1538696356 | Justin J Lewis | Occupational Therapy Assistant | 141 Hospital Dr, Ste 102, Salem, KY 42078-8043 | 2017-05-11 |
| 1558784769 | Kristee Croft Shoulders | Registered Nurse | 141 Hospital Dr, Salem, KY 42078-8043 | 2014-01-23 |
| 1649430778 | Terry W Boone | Physician Assistant | 141 Hospital Dr, Salem, KY 42078-8043 | 2008-06-12 |
| 1669566170 | Salem Clinic Pharmacy Inc | Durable Medical Equipment & Medical Supplies | 141 Hospital Dr, Salem, KY 42078-8043 | 2006-10-02 |
| 1902822661 | Deborah B Dutton | Nurse Practitioner | 141 Hospital Dr, Salem, KY 42078-8043 | 2006-07-14 |
| 1538127378 | Ghassan Yazigi | Family Medicine | 141 Hospital Dr, Salem, KY 42078-8043 | 2006-05-02 |
| 1396708566 | James Todd Bergin | Specialist | 141 Hospital Dr, Salem, KY 42078-8043 | 2006-04-10 |
| 1669442620 | Michael Philip Gavin | Surgery | 141 Hospital Dr, Salem, KY 42078-8043 | 2006-01-24 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1760523120 | Shannon Federico | Pharmacist | 119 East Main St., Salem, KY 42078 | 2007-02-09 |
| 1730275892 | Michael L Keller | Pharmacist | 141 Hospital Drive, Salem, KY 42078 | 2006-10-05 |
| 1629597638 | Misty Jones Turmero | Pharmacist | 119 East Main St., Salem, KY 42078 | 2017-09-12 |
| 1740689876 | Codie L Parks | Pharmacist | 131 Hospital Drive, Salem, KY 42078 | 2014-08-14 |
| 1265481022 | Crittenden County Hospital | Clinic/Center | 117 E Main St, Salem, KY 42078 | 2006-05-09 |
| 1891859799 | R V Bharne Psc | Family Medicine | 501 N Hayden Avenue, Salem, KY 42078-0376 | 2006-12-22 |
| 1215072020 | Bradley A Boone | Pharmacist | 141hospital Dr, Clinic Pharmacy, Salem, KY 42078-0498 | 2007-02-20 |
| 1073162475 | Lori Guill | Speech-Language Pathologist | 508 N Hayden Ave, Salem, KY 42078-8008 | 2019-09-09 |
| 1366543837 | Orion Salem LLC | Skilled Nursing Facility | 509 N Hayden Ave, Salem, KY 42078-8008 | 2006-09-26 |
| 1023326436 | Lifeline Homecare of Salem LLC | Clinic/Center | 503 E Main St, Salem, KY 42078-8033 | 2010-09-20 |
| Find all providers in zip 42078 | ||||
| Taxonomy Code | 261QR1300X |
| Grouping | Ambulatory Health Care Facilities |
| Classification | Clinic/Center |
| Specialization | Rural Health |
| Definition to come... |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1679600936 | Ozarks Medical Center | Clinic/Center | 172 Hwy 62 East, Suite 1, Salem, AR 72576 | 2007-02-27 |
| 1821089657 | Salem Memorial Hospital | Clinic/Center | 35629 Highway 72 Bldg II, Salem, MO 65560-7217 | 2005-11-01 |
| 1639174568 | Avera Queen of Peace | Clinic/Center | 741 S Hill St, Salem, SD 57058-8761 | 2005-06-16 |
| 1649830472 | Salem Township Hospital | Clinic/Center | 1321 W Whittaker St, Salem, IL 62881-2013 | 2019-06-14 |
| 1316411655 | Crittenden Community Hospital LLC | Clinic/Center | 117 E Main St, Salem, KY 42078-9998 | 2019-01-21 |
| 1922345800 | Salem Memorial Hospital | Clinic/Center | 35629 Highway 72, Building 1, Salem, MO 65560-7217 | 2013-01-11 |
| 1194077701 | Pcrmc Medical Group, Inc | Clinic/Center | 1415 W Scenic Rivers Blvd, Salem, MO 65560-2840 | 2012-10-05 |
| 1023326436 | Lifeline Homecare of Salem LLC | Clinic/Center | 503 E Main St, Salem, KY 42078-8033 | 2010-09-20 |
| 1619201829 | Avera Queen of Peace | Clinic/Center | 741 S Hill St, Salem, SD 57058-8761 | 2009-09-22 |
| 1619109543 | Physician Services Corp of Southern Illinois | Clinic/Center | 1250 W Whittaker St, Salem, IL 62881-1917 | 2009-08-11 |
| Find all providers in SALEM | ||||
Please comment or provide details below to improve the information on TRI-RIVERS HEALTHCARE PLLC.
| 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.