| Organization Name: | TRI STATE CLINIC, INC. |
| NPI Number: | 1124097795 |
| Entity Type Code: | Organizational (2) |
| Authorized Official Name: | JANET STACY (ADMINISTRATOR) |
| Mailing Address: | 1520 Slate Creek Rd Grundy |
| State: | VA US |
| Postal Code: | 246146975 |
| Phone Number: | 2769358620 |
| Fax Number: | 2769354430 |
| NPI Enumeration Date: | 03/16/2006 |
| NPI Last Update Date: | 03/09/2010 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 261QR1300X |
| License Number: | |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | |
| Taxonomy Type: | Ambulatory Health Care Facilities |
| Taxonomy Classification: | Clinic/Center |
| Taxonomy Specialization: | Rural Health |
| Taxonomy Definition: | |