NPIMap

Organization Active NPI

Tri State Family Medical Center, LLC

  • Family Medicine Physician
  • Louisa, KY
National Provider Identifier
1194959452
Registry record updated Dec 9, 2014
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
License
25469 Issued in KY
Legal business name
TRI STATE FAMILY MEDICAL CENTER, LLC
Practice address
2583 Highway 644 Ste 1
Louisa, KY 41230-9436
Phone
(606) 638-3131
Fax
(606) 638-3139
NPI assigned
May 14, 2009
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Dec 9, 2014

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Mrs. Janice Gauze
Title
Vice President
Phone
(606) 638-3131

Specialties & licenses 4

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 207Q00000X 25469 KY Primary
Primary Care Clinic/Center 261QP2300X 25469 KY
Urgent Care Clinic/Center 261QU0200X 25469
Family Nurse PractitionerGroup: 193200000X MULTI-SPECIALTY GROUP 363LF0000X 3007167 KY

Addresses

Primary practice location

2583 Highway 644 Ste 1
Louisa, KY 41230-9436

Mailing address

2583 Highway 644 Ste 1
Louisa, KY 41230-9436
Phone (606) 638-3131

National Provider Directory

National Provider Directory

Locations

2583 Highway 644
Ste 1
Louisa, KY 41230
Phone (606) 638-3131

2583 Highway 644
#2
Louisa, KY 41230
Phone (606) 638-3131

Practitioners & affiliated clinicians

Practitioners 2

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1242259200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1418083200000",
    "number": "1194959452",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2583 HIGHWAY 644 STE 1",
            "city": "LOUISA",
            "state": "KY",
            "postal_code": "412309436",
            "telephone_number": "606-638-3131",
            "fax_number": "606-638-3139"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2583 HIGHWAY 644 STE 1",
            "city": "LOUISA",
            "state": "KY",
            "postal_code": "412309436",
            "telephone_number": "606-638-3131",
            "fax_number": "606-638-3139"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "TRI STATE FAMILY MEDICAL CENTER, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2009-05-14",
        "last_updated": "2014-12-09",
        "status": "A",
        "authorized_official_last_name": "GAUZE",
        "authorized_official_first_name": "JANICE",
        "authorized_official_title_or_position": "VICE PRESIDENT",
        "authorized_official_telephone_number": "606-638-3131",
        "authorized_official_name_prefix": "Mrs."
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Family Medicine",
            "state": "KY",
            "license": "25469",
            "primary": true
        },
        {
            "code": "261QP2300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Primary Care",
            "state": "KY",
            "license": "25469",
            "primary": false
        },
        {
            "code": "261QU0200X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Urgent Care",
            "state": null,
            "license": "25469",
            "primary": false
        },
        {
            "code": "363LF0000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Nurse Practitioner, Family",
            "state": "KY",
            "license": "3007167",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Louisa, KY

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 9, 2014; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.