Healthcare Provider Details

I. General information

NPI: 1285002634
Provider Name (Legal Business Name): TRI STATE COMMUNITY HEALTH CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/02/2015
Last Update Date: 03/26/2024
Certification Date: 03/26/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4041 KNIGHT ARNOLD RD SUITE 100
MEMPHIS TN
38118-2128
US

IV. Provider business mailing address

4041 KNIGHT ARNOLD RD SUITE 100
MEMPHIS TN
38118-2128
US

V. Phone/Fax

Practice location:
  • Phone: 901-360-0442
  • Fax: 901-360-0865
Mailing address:
  • Phone: 901-360-0442
  • Fax: 901-360-0865

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QC1500X
TaxonomyCommunity Health Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: ALBERT L RICHARDSON
Title or Position: CHIEF EXECUTIVE OFFICER
Credential:
Phone: 901-360-0442