Healthcare Provider Details

I. General information

NPI: 1699895003
Provider Name (Legal Business Name): TRI-RIVERS HEALTHCARE PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/30/2007
Last Update Date: 07/23/2026
Certification Date: 07/23/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

308 S MAIN ST
MARION KY
42064-1545
US

IV. Provider business mailing address

141 HOSPITAL DR
SALEM KY
42078-8043
US

V. Phone/Fax

Practice location:
  • Phone: 270-965-4377
  • Fax: 270-965-9569
Mailing address:
  • Phone: 270-988-3298
  • Fax: 270-988-4642

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License Number
License Number State
# 4
Primary TaxonomyY
Taxonomy Code261QR1300X
TaxonomyRural Health Clinic/Center
License Number900215
License Number StateKY
# 5
Primary TaxonomyN
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License Number
License Number State
# 6
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number
License Number State

VIII. Authorized Official

Name: MICHAEL A HENEISEN
Title or Position: AGENT
Credential:
Phone: 270-988-3298