Look up the most recent NPI and PECOS records

Tri-State Family Medicine, Psc

Family Medicine

Allopathic & Osteopathic Physicians

PECOS Enrollment

Based on the most recent information from CMS, provider Tri-State Family Medicine, Psc does not have current enrollment records in PECOS.

Part B
Medicare Part B
Not Enrolled
HHA
Home Health Agency
Not Enrolled
DME
Durable Medical Equipment
Not Enrolled
PMD
Power Mobility Device
Not Enrolled

CMS last updated its PECOS records yesterday at 1:10 PM.

Profile Details

Provider ID
1447291240
Provider Type
Organization
Full Name
Tri-State Family Medicine, Psc

Subpart
No
Enumeration Date
6/10/2006
Last Updated
8/22/2020

Contact Information

Practice Location

941 29th St, Ashland, KY 41101-3021

(606) 327-4445

Unlisted Fax

Mailing Location

941 29th St, Ashland, KY 41101-3021

(606) 327-4445

Unlisted Fax

Authorized Official

Kayfan, Arash Daemi (Owner)

(606) 327-4445

Provider Taxonomies

Code	Description	License
Code 207Q00000X Primary	Description Family Medicine Allopathic & Osteopathic Physicians	License 02726 Kentucky

Provider Identifiers

ID	Description	Issuer
ID 000000208077	Description Other	Issuer BC/BS Kentucky
ID 2297492	Description Medicaid	Issuer Unlisted Ohio
ID 64041908	Description Medicaid	Issuer Unlisted Kentucky

Tri-State Family Medicine, Psc

PECOS Enrollment

Profile Details

Contact Information

Practice Location

Mailing Location

Authorized Official

Provider Taxonomies

Code

Description

License

Code

Description

License

Provider Identifiers

ID

Description

Issuer

ID

Description

Issuer

ID

Description

Issuer

ID

Description

Issuer

Adams-Slone, Rita D

Hannah, Rancie Wayne

Cassity, Abbe Marissa

Ovp Health Care Inc

Jones, Derek W,

Ashland Primary Care Psc

Short, William Joseph

Ashland Family Medicine

Abbe M. Cassity Do Psc

Bagley, Michele L