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General NPI Number Information
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NPI Number | 1598885998
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Entity Type | Organization
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Legal Business Name | TRI-RIVERS HEALTHCARE PLLC
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Dates
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Enumeration Date | 03/30/2007
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Last Update Date | 01/06/2015
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Provider Practice Location Address
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Address Line | 205 E ADAIR ST
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City | SMITHLAND
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State | KY
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Zip | 42081-9507
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Country | US
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Telephone | 270-928-2146
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Fax | 270-928-4492
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Provider Business Mailing Address
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Address Line | 141 HOSPITAL DRIVE PO BOX 347
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City | SALEM
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State | KY
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Zip | 42078-0347
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Country | US
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Telephone | 270-988-3298
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Fax | 270-988-4642
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Authorized Official
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Title or Position | AGENT
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Name | MR. MICHAEL ALBIN HENEISEN
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Credential |
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Telephone | 270-988-3298
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 208600000X
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Taxonomy Name | Surgery Physician
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 208D00000X
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Taxonomy Name | General Practice Physician
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License Number |
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License Number State |
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Taxonomy #4
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Taxonomy Code | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number |
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License Number State |
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Taxonomy #5
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number |
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License Number State |
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Taxonomy #6
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Taxonomy Code | 261QR1300X
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Taxonomy Name | Rural Health Clinic/Center
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License Number | 900217
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License Number State | KY
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