Healthcare Provider Details

I. General information

NPI: 1174934418
Provider Name (Legal Business Name): TRI COUNTY HEALTH CLINIC, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/08/2014
Last Update Date: 07/07/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

13510 FOUNTAIN RUN RD
FOUNTAIN RUN KY
42133-7915
US

IV. Provider business mailing address

13510 FOUNTAIN RUN RD
FOUNTAIN RUN KY
42133-7915
US

V. Phone/Fax

Practice location:
  • Phone: 270-434-3100
  • Fax: 270-434-3102
Mailing address:
  • Phone: 270-434-3100
  • Fax: 270-434-3102

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code364SF0001X
TaxonomyFamily Health Clinical Nurse Specialist
License Number
License Number State

VIII. Authorized Official

Name: MR. LARRY TINSLEY
Title or Position: OWNER
Credential:
Phone: 270-576-0176