Healthcare Provider Details

I. General information

NPI: 1649454034
Provider Name (Legal Business Name): TRI STATE URGENT CARE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/21/2007
Last Update Date: 07/21/2022
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3699 ALEXANDRIA PK
COLD SPRING KY
41076
US

IV. Provider business mailing address

3699 ALEXANDRIA PK COLD SPRING URGENT CARE
COLD SPRING KY
41076
US

V. Phone/Fax

Practice location:
  • Phone: 859-442-8444
  • Fax: 859-442-8777
Mailing address:
  • Phone: 859-442-8444
  • Fax: 859-442-8777

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code364SA2100X
TaxonomyAcute Care Clinical Nurse Specialist
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code261QE0002X
TaxonomyEmergency Care Clinic/Center
License Number
License Number StateKY

VIII. Authorized Official

Name: MS. THORAYA HASSAN
Title or Position: MANANDER
Credential:
Phone: 513-531-1555