Healthcare Provider Details

I. General information

NPI: 1215131586
Provider Name (Legal Business Name): TRI-COUNTY FAMILY MEDICINE PROGRAM, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/12/2007
Last Update Date: 10/30/2025
Certification Date: 10/30/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

200 N MAIN ST
WAYLAND NY
14572-1034
US

IV. Provider business mailing address

10869 STATE ROUTE 36
DANSVILLE NY
14437-9444
US

V. Phone/Fax

Practice location:
  • Phone: 585-728-5131
  • Fax: 585-728-9305
Mailing address:
  • Phone: 585-335-3100
  • Fax: 585-335-8695

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number2527200R
License Number StateNY
# 2
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number2527200R
License Number StateNY

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name: KAREN A STONE
Title or Position: CEO
Credential:
Phone: 585-519-1575