Provider Demographics
NPI:1588649503
Name:TRI-COUNTY FAMILY MEDICINE PROGRAM, INC.
Entity Type:Organization
Organization Name:TRI-COUNTY FAMILY MEDICINE PROGRAM, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:NICHOLAS
Authorized Official - Middle Name:H
Authorized Official - Last Name:APOSTOLERIS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:585-335-3100
Mailing Address - Street 1:PO BOX 601
Mailing Address - Street 2:10869 RTE 36 SOUTH
Mailing Address - City:DANSVILLE
Mailing Address - State:NY
Mailing Address - Zip Code:14437-0601
Mailing Address - Country:US
Mailing Address - Phone:585-335-3416
Mailing Address - Fax:585-335-8695
Practice Address - Street 1:10869 STATE ROUTE 36 SOUTH
Practice Address - Street 2:
Practice Address - City:DANSVILLE
Practice Address - State:NY
Practice Address - Zip Code:14437-0601
Practice Address - Country:US
Practice Address - Phone:585-335-3416
Practice Address - Fax:585-335-8695
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:TRI-COUNTY FAMILY MEDICINE PROGRAM, INC.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2005-12-13
Last Update Date:2022-12-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY2527200R207Q00000X, 208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
No208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00355257Medicaid
NYCF7445Medicare PIN
NY00355257Medicaid