Provider Demographics
NPI:1710025754
Name:TRI-RIVERS FAMILY PLANNING, INC.
Entity Type:Organization
Organization Name:TRI-RIVERS FAMILY PLANNING, INC.
Other - Org Name:TRI-RIVERS PLANNED PARENTHOOD, INC.
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:PRESIDENT CEO
Authorized Official - Prefix:
Authorized Official - First Name:TONIA
Authorized Official - Middle Name:R
Authorized Official - Last Name:STUBBLEFIELD
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:573-364-1509
Mailing Address - Street 1:PO BOX 359
Mailing Address - Street 2:
Mailing Address - City:ROLLA
Mailing Address - State:MO
Mailing Address - Zip Code:65402-0359
Mailing Address - Country:US
Mailing Address - Phone:573-364-1509
Mailing Address - Fax:573-364-6520
Practice Address - Street 1:1032 KINGSHIGHWAY ST STE B
Practice Address - Street 2:
Practice Address - City:ROLLA
Practice Address - State:MO
Practice Address - Zip Code:65401-2921
Practice Address - Country:US
Practice Address - Phone:573-364-1509
Practice Address - Fax:573-364-6520
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-02
Last Update Date:2011-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QF0050XAmbulatory Health Care FacilitiesClinic/CenterFamily Planning, Non-Surgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO521801001Medicaid
MO000013501Medicare ID - Type Unspecified