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NPI Code Detail

MEDICARE: TRI STATE COMMUNITY HEALTH CENTER

MEDICARE: TRI STATE COMMUNITY HEALTH CENTER
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1261QC1500XCommunity Health Clinic/Center
2261QF0400XFederally Qualified Health Center (FQHC)

General Provider Information

NPI Number : 1285002634
Entity Type Code : Organization
Provider Name (Legal Business Name) : TRI STATE COMMUNITY HEALTH CENTER
Provider Business Mailing Address
First Line : 4041 KNIGHT ARNOLD RD
Second Line : SUITE 100
City : MEMPHIS
State : TN
Zip : 38118-2128
Country : US
Telephone Number : 901-360-0442
Fax Number : 901-360-0865
Provider Business Practice Location Address
First Line : 4041 KNIGHT ARNOLD RD
Second Line : SUITE 100
City : MEMPHIS
State : TN
Zip : 38118-2128
Country : US
Telephone Number : 901-360-0442
Fax Number : 901-360-0865
Authorized Official
Title or Position : CHIEF EXECUTIVE OFFICER
Name : ALBERT L RICHARDSON
Credential :
Telephone Number : 901-360-0442
Provider Enumeration Date : 09/02/2015
Last Update Date : 06/08/2026

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Directions to “TRI STATE COMMUNITY HEALTH CENTER ” Practice Location

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