Tri State Clinic, INC.
Clinic/Center, Rural Health in Grundy, VA. Organization (NPI-2).
NPI number1124097795
StatusActive
Last updated in NPPESMar 9, 2010
Details
- NPI
- 1124097795
- Entity type
- Organization (NPI-2)
- Legal business name
- Tri State Clinic, INC.
- Organization subpart
- No
- Enumeration date
- Mar 16, 2006
- Last updated
- Mar 9, 2010
Medicare and OIG
- Medicare enrolled (PECOS)
- Yes · PART A PROVIDER - RURAL HEALTH CLINIC
- Can order and refer
- Not on the CMS order and referring list
- OIG exclusion list
- This NPI is not listed
CMS and OIG files of November 2026. PECOS lookup · OIG exclusion check
Taxonomy and licenses
| Taxonomy code | Description | License | State | Primary |
|---|---|---|---|---|
| 261QR1300X | Clinic/Center, Rural Health | – | – | Yes |
Other names
- Tri State Rural Health Clinic (Doing Business As)
Practice location
1520 Slate Creek RdGrundy, VA 24614-6975
Phone 276-935-8620 · Fax 276-935-4430
Mailing address
1520 Slate Creek RdGrundy, VA 24614-6975
Phone 276-935-8620 · Fax 276-935-4430
Authorized official
Janet Stacy
Administrator
2769358620
Is something wrong?
This page shows exactly what the provider filed with NPPES. Only the provider (or their surrogate) can change it, by signing in to NPPES. Our page updates within a day of their change. See how to update NPI information.
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All 7 Rural Health Clinic/Center providers in Grundy · All 157 providers in Grundy
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