| NPI | 1720146319 |
|---|---|
| Former Legal Business Name | TRI STATE COMMUNITY HEALTH CENTER |
| Entity Type | Organization |
| Authorized Contact | JOELLE NICOLE CLEMENS Credentialing Specialist 563-690-5206 |
| Organization Subpart ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: IA A100692) |
| Additional Taxonomies | 122300000X Dentist (Licence: IA 08349) |
| Enumeration Date | 2006-12-05 |
| Last Update Date | 2023-08-10 |