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TRI STATE MEDICAL CENTER PLLC NPI 1073390944


NPI Information

NPI: 1073390944
Provider Name: TRI STATE MEDICAL CENTER PLLC

Former Legal Business Name: TRI STATE MEDICAL CENTER PLLC

Classification: Nurse Practitioner - 363L00000X
Entity Type: Organization

CLIA Number: 43D2292092

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

No. Taxonomy Code Taxonomy Clasification Taxonomy Specialization License Number License State Primary
1363L00000XNurse PractitionerYes

What is NPI?

NPI stands for National Provider Identifier. The NPI is a 10-digit identification number that is completely unique. The NPI number by itself does not contain any identifiable information such as a provider’s speciality or location. The NPI is assigned to individuals or organizacions for their lifespan and it is independent of key provider information type updates like a change of practices, location or speciality.

This page was last updated on: 5/5/2024

All materials and services on this site are provided on an "as is" and "as available" basis without warranty of any kind. The NPI record is maintained by the National Plan & Provider Enumeration System (NPPES) and anyone may request this information and other NPPES health care provider data from HHS under The Freedom of Information Act (FOIA), Title 5 of the United States Code, section 552. To update the NPI records please contact the NPPES.