| Tri-state Community Health Center, Inc | |
|
621 Kelly Rd Cumberland MD 21502-2878 | |
| (301) 722-3270 | |
| (301) 722-3276 |
| Full Name | Tri-state Community Health Center, Inc |
|---|---|
| Speciality | Clinic/Center |
| Location | 621 Kelly Rd, Cumberland, Maryland |
| Authorized Official Name and Position | Sheila J Deshong (EXECUTIVE DIRECTOR) |
| Authorized Official Contact | 3016787256 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Tri-state Community Health Center, Inc 130 W High St Hancock MD 21750-1143 Ph: (301) 678-7256 | Tri-state Community Health Center, Inc 621 Kelly Rd Cumberland MD 21502-2878 Ph: (301) 722-3270 |
| NPI Number | 1457301939 |
|---|---|
| Provider Enumeration Date | 05/12/2006 |
| Last Update Date | 10/14/2008 |
| Medicare PECOS PAC ID | 9335057355 |
|---|---|
| Medicare Enrollment ID | O20030108000007 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1457301939 | NPI | - | NPPES |
| 1723320/02 | Medicaid | PA | |
| 0035061003 | Medicaid | WV | |
| 482501201 | Medicaid | MD |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QF0400X | Clinic/center - Federally Qualified Health Center (fqhc) | (* (Not Available)) | Primary |
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