Provider Demographics
NPI:1649474701
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:
Authorized Official - First Name:KAREN
Authorized Official - Middle Name:A
Authorized Official - Last Name:STONE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:585-335-3416
Mailing Address - Street 1:10869 RTE 36 SOUTH
Mailing Address - Street 2:PO BOX 601
Mailing Address - City:DANSVILLE
Mailing Address - State:NY
Mailing Address - Zip Code:14437-9444
Mailing Address - Country:US
Mailing Address - Phone:585-335-3416
Mailing Address - Fax:585-335-8695
Practice Address - Street 1:12 N CHURCH ST
Practice Address - Street 2:
Practice Address - City:CANASERAGA
Practice Address - State:NY
Practice Address - Zip Code:14822-9721
Practice Address - Country:US
Practice Address - Phone:607-545-8333
Practice Address - Fax:607-545-8677
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-06-13
Last Update Date:2025-02-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY333827Medicare PIN