Provider Demographics
NPI:1689842130
Name:TRI-STATE COMPREHENSIVE CARE PLLC
Entity Type:Organization
Organization Name:TRI-STATE COMPREHENSIVE CARE PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEMBER
Authorized Official - Prefix:
Authorized Official - First Name:DANIEL
Authorized Official - Middle Name:
Authorized Official - Last Name:HENRY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:270-844-8144
Mailing Address - Street 1:2000 N ELM ST
Mailing Address - Street 2:SUITE 1A
Mailing Address - City:HENDERSON
Mailing Address - State:KY
Mailing Address - Zip Code:42420-2385
Mailing Address - Country:US
Mailing Address - Phone:270-844-8144
Mailing Address - Fax:270-844-8145
Practice Address - Street 1:2000 N ELM ST
Practice Address - Street 2:SUITE 1A
Practice Address - City:HENDERSON
Practice Address - State:KY
Practice Address - Zip Code:42420-2385
Practice Address - Country:US
Practice Address - Phone:270-844-8144
Practice Address - Fax:270-844-8145
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-02-19
Last Update Date:2008-02-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary DiseaseGroup - Multi-Specialty
No207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty