Provider Demographics
NPI:1427416361
Name:TRIBBETT FAMILY MEDICINE, LLC
Entity Type:Organization
Organization Name:TRIBBETT FAMILY MEDICINE, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:CHARLES
Authorized Official - Middle Name:R
Authorized Official - Last Name:TRIBBETT
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:574-240-1111
Mailing Address - Street 1:301 W HARRISON ST
Mailing Address - Street 2:
Mailing Address - City:MONTICELLO
Mailing Address - State:IN
Mailing Address - Zip Code:47960-2211
Mailing Address - Country:US
Mailing Address - Phone:574-240-1111
Mailing Address - Fax:574-240-1113
Practice Address - Street 1:301 W HARRISON ST
Practice Address - Street 2:
Practice Address - City:MONTICELLO
Practice Address - State:IN
Practice Address - Zip Code:47960-2211
Practice Address - Country:US
Practice Address - Phone:574-240-1111
Practice Address - Fax:574-240-1113
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-02-06
Last Update Date:2023-04-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN01036854A207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN100262800Medicaid
IN100262800Medicaid
IN921430AMedicare Oscar/Certification