MEDICARE: TRI-STATE COMMUNITY HEALTHCARE CENTER

Medicare Provider Information

Scope of Practice

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

#	Taxonomy Code	Taxonomy
1	261QC1500X	Community Health Clinic/Center
2	261QP2300X	Primary Care Clinic/Center
3	261QF0400X	Federally Qualified Health Center (FQHC)

General Provider Information

NPI Number	:	1841703253
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	TRI-STATE COMMUNITY HEALTHCARE CENTER

Provider Business Mailing Address
First Line	:	8700 S HIGHWAY 95
Second Line	:
City	:	MOHAVE VALLEY
State	:	AZ
Zip	:	86440-8519
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	8700 S HIGHWAY 95
Second Line	:
City	:	MOHAVE VALLEY
State	:	AZ
Zip	:	86440-8519
Country	:	US
Telephone Number	:	928-768-7113
Fax Number	:

Authorized Official
Title or Position	:	CEO
Name	:	ARAM MANOUKIAN
Credential	:	CEO
Telephone Number	:	760-326-0222

Provider Enumeration Date	:	11/07/2017
Last Update Date	:	11/07/2017

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Directions to “TRI-STATE COMMUNITY HEALTHCARE CENTER ” Practice Location

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