=====================================================
General NPI Number Information
=====================================================
NPI Number | 1295939353
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | TRI-COUNTY FAMILY MEDICINE PROGRAM, INC.
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 06/13/2007
-----------------------------------------------------
Last Update Date | 11/03/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 61 N STATE ST
-----------------------------------------------------
City | NUNDA
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 14517-9785
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 585-468-2528
-----------------------------------------------------
Fax | 585-468-5424
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 10869 STATE ROUTE 36
-----------------------------------------------------
City | DANSVILLE
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 14437-9444
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 585-335-3100
-----------------------------------------------------
Fax | 585-335-8695
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | CEO
-----------------------------------------------------
Name | KAREN A STONE
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 585-335-3416
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207Q00000X
-----------------------------------------------------
Taxonomy Name | Family Medicine Physician
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------