| Tri-state Family Healthcare | |
|
3503 Cumberland Ave Middlesboro KY 40965-2611 | |
| (606) 242-3100 | |
| (606) 242-3984 |
| Full Name | Tri-state Family Healthcare |
|---|---|
| Speciality | Clinic/Center |
| Location | 3503 Cumberland Ave, Middlesboro, Kentucky |
| Authorized Official Name and Position | Larry B Roark (NURSE PRACTITIONER/OWNER) |
| Authorized Official Contact | 6062423100 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Tri-state Family Healthcare Po Box 217 Middlesboro KY 40965-0217 Ph: (606) 242-3100 | Tri-state Family Healthcare 3503 Cumberland Ave Middlesboro KY 40965-2611 Ph: (606) 242-3100 |
| NPI Number | 1649370719 |
|---|---|
| Provider Enumeration Date | 09/25/2006 |
| Last Update Date | 01/31/2020 |
| Medicare PECOS PAC ID | 5890713424 |
|---|---|
| Medicare Enrollment ID | O20051102000889 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1649370719 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QR1300X | Clinic/center - Rural Health | (* (Not Available)) | Primary |
| 363LF0000X | Nurse Practitioner - Family | (* (Not Available)) | Secondary |
| Provider Name | Larry Brandon Roark |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1437281649 PECOS PAC ID: 6800989195 Enrollment ID: I20070831000321 |
| Provider Name | Rebecca Banfield |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1124552369 PECOS PAC ID: 8224302963 Enrollment ID: I20170920000166 |
| Provider Name | Kristy Smith |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1427600790 PECOS PAC ID: 9537591094 Enrollment ID: I20191121001591 |
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