Provider Demographics
NPI:1174934418
Name:TRI COUNTY HEALTH CLINIC, LLC
Entity type:Organization
Organization Name:TRI COUNTY HEALTH CLINIC, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:LARRY
Authorized Official - Middle Name:
Authorized Official - Last Name:TINSLEY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:270-576-0176
Mailing Address - Street 1:13510 FOUNTAIN RUN RD
Mailing Address - Street 2:
Mailing Address - City:FOUNTAIN RUN
Mailing Address - State:KY
Mailing Address - Zip Code:42133-7915
Mailing Address - Country:US
Mailing Address - Phone:270-434-3100
Mailing Address - Fax:270-434-3102
Practice Address - Street 1:13510 FOUNTAIN RUN RD
Practice Address - Street 2:
Practice Address - City:FOUNTAIN RUN
Practice Address - State:KY
Practice Address - Zip Code:42133-7915
Practice Address - Country:US
Practice Address - Phone:270-434-3100
Practice Address - Fax:270-434-3102
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-05-08
Last Update Date:2014-07-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes364SF0001XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse SpecialistFamily HealthGroup - Single Specialty