TRI STATE MEDICAL CENTER PLLC NPI 1073390944

NPI Details

TRI STATE MEDICAL CENTER PLLC is a nurse practitioner in Belle Fourche, SD. The provider is (1) A registered nurse provider with a graduate degree in nursing prepared for advanced practice involving independent and interdependent decision making and direct accountability for clinical judgment across the health care continuum or in a certified specialty. (2) A registered nurse who has completed additional training beyond basic nursing education and who provides primary health care services in accordance with state nurse practice laws or statutes. Tasks performed by nurse practitioners vary with practice requirements mandated by geographic, political, economic, and social factors. Nurse practitioner specialists include, but are not limited to, family nurse practitioners, gerontological nurse practitioners, pediatric nurse practitioners, obstetric-gynecologic nurse practitioners, and school nurse practitioners. TRI STATE MEDICAL CENTER PLLC NPI is 1073390944. The provider is registered as an organization entity type.
The provider Former Legal Business Name Is Tri State Medical Center Pllc.

The provider's business location address is:

2398 5TH AVE STE 101
BELLE FOURCHE, SD
ZIP 57717-340
Phone: (605) 645-2064

The provider's authorized official is Vanessa Kudlock .
The authorized official title is Owner and has the following contact phone number (605) 568-0191.

The CLIA number assigned to this NPI record is 43D2292092 - practitioner other with a certificate type of Certificate of Waiver.

The enumeration date for this NPI number is 9/13/2023 and was last updated on 1/11/2024.

Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available: