NPIMap

Organization Active NPI

Tri-State Community Health Center, Inc

  • Family Nurse Practitioner
  • Cumberland, MD
National Provider Identifier
1659709277
Registry record updated Oct 16, 2013
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Nurse PractitionerTaxonomy code 363LF0000X
License
R200178 Issued in MD
Legal business name
TRI-STATE COMMUNITY HEALTH CENTER, INC
Practice address
621 Kelly Rd
Cumberland, MD 21502-2878
Phone
(301) 722-3270
Fax
(301) 678-3276
NPI assigned
Oct 16, 2013
Last updated
Oct 16, 2013By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Oct 16, 2013

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

Authorized official

Name
Satricia A Woodal
Title
HR Manager
Phone
(301) 678-5187

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Nurse PractitionerGroup: 193400000X SINGLE SPECIALTY GROUP 363LF0000X R200178 MD Primary

Addresses

Primary practice location

621 Kelly Rd
Cumberland, MD 21502-2878

Mailing address

109 Rayloc Dr
Hancock, MD 21750-1518
Phone (301) 678-5187

Other identifiers 1

IdentifierTypeStateIssuer
211828OtherMDMEDICARE FQHC

National Provider Directory

National Provider Directory
Tax ID family
Tri-State Community Health Center Inc7 organizations share this tax ID, including this one

Other organizations with this tax ID 6

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": "1381881600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1381881600000",
    "number": "1659709277",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "109 RAYLOC DR",
            "city": "HANCOCK",
            "state": "MD",
            "postal_code": "217501518",
            "telephone_number": "301-678-5187",
            "fax_number": "301-678-5797"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "621 KELLY RD",
            "city": "CUMBERLAND",
            "state": "MD",
            "postal_code": "215022878",
            "telephone_number": "301-722-3270",
            "fax_number": "301-678-3276"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "TRI-STATE COMMUNITY HEALTH CENTER, INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2013-10-16",
        "last_updated": "2013-10-16",
        "status": "A",
        "authorized_official_last_name": "WOODAL",
        "authorized_official_first_name": "SATRICIA",
        "authorized_official_middle_name": "A",
        "authorized_official_title_or_position": "HR MANAGER",
        "authorized_official_telephone_number": "301-678-5187"
    },
    "taxonomies": [
        {
            "code": "363LF0000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Nurse Practitioner, Family",
            "state": "MD",
            "license": "R200178",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICARE FQHC",
            "identifier": "211828",
            "state": "MD"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Cumberland, MD

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 16, 2013; 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.