NPIMap

Organization Active NPI

Tristate Rural Health Clinic

  • Legal Medicine
  • Grundy, VA
National Provider Identifier
1568622868
Registry record updated Jun 11, 2008
On this page

Key facts

NPPES NPI Registry
Primary specialty
Legal MedicineTaxonomy code 173000000X
License
0101031664 Issued in VA
Legal business name
TRISTATE RURAL HEALTH CLINIC
Practice address
20757 Riverside Dr
Grundy, VA 24614-6746
Phone
(276) 935-6424
Fax
(276) 935-2494
NPI assigned
Jun 11, 2008
Last updated
Jun 11, 2008By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jun 11, 2008

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

Authorized official

Name
Mrs. Janet Stacy
Title
Office Manager
Phone
(276) 935-6044

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Legal Medicine 173000000X 0101031664 VA Primary

Addresses

Primary practice location

20757 Riverside Dr
Grundy, VA 24614-6746

Mailing address

20757 Riverside Dr
Grundy, VA 24614-6746
Phone (276) 935-6055

Other identifiers 1

IdentifierTypeStateIssuer
006091750MedicaidVA

National Provider Directory

National Provider Directory
Tax ID family
Tri State Clinic3 organizations share this tax ID, including this one

Other organizations with this tax ID 2

Organizations that report the same tax identification number in the National Provider Directory.

NPI Registry JSON

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

{
    "created_epoch": "1213142400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1213142400000",
    "number": "1568622868",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "20757 RIVERSIDE DR",
            "city": "GRUNDY",
            "state": "VA",
            "postal_code": "246146746",
            "telephone_number": "276-935-6055",
            "fax_number": "276-935-4430"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "20757 RIVERSIDE DR",
            "city": "GRUNDY",
            "state": "VA",
            "postal_code": "246146746",
            "telephone_number": "276-935-6424",
            "fax_number": "276-935-2494"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "TRISTATE RURAL HEALTH CLINIC",
        "organizational_subpart": "NO",
        "enumeration_date": "2008-06-11",
        "last_updated": "2008-06-11",
        "status": "A",
        "authorized_official_last_name": "STACY",
        "authorized_official_first_name": "JANET",
        "authorized_official_title_or_position": "OFFICE MANAGER",
        "authorized_official_telephone_number": "276-935-6044",
        "authorized_official_name_prefix": "Mrs."
    },
    "taxonomies": [
        {
            "code": "173000000X",
            "taxonomy_group": "",
            "desc": "Legal Medicine",
            "state": "VA",
            "license": "0101031664",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "006091750",
            "state": "VA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Grundy, VA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 11, 2008; 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.