Tri-state Community Health Center, Inc | |
130 W High St Hancock MD 21750-1143 | |
(301) 678-5187 | |
(301) 678-5797 |
Full Name | Tri-state Community Health Center, Inc |
---|---|
Speciality | Clinic/Center |
Location | 130 W High St, Hancock, Maryland |
Authorized Official Name and Position | Sheila J Deshong (EXECUTIVE DIRECTOR) |
Authorized Official Contact | 3016787256 |
Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
Mailing Address | Practice Location Address |
---|---|
Tri-state Community Health Center, Inc 109 Rayloc Dr Hancock MD 21750-1518 Ph: (301) 678-5187 | Tri-state Community Health Center, Inc 130 W High St Hancock MD 21750-1143 Ph: (301) 678-5187 |
NPI Number | 1366491201 |
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Provider Enumeration Date | 05/09/2006 |
Last Update Date | 08/03/2010 |
Medicare PECOS PAC ID | 9335057355 |
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Medicare Enrollment ID | O20040219000462 |
Identifier | Type | State | Issuer |
---|---|---|---|
1366491201 | NPI | - | NPPES |
0035061000 | Medicaid | WV | |
1723320/01 | Medicaid | PA | |
482501200 | Medicaid | MD |
Taxonomy | Type | License (State) | Status |
---|---|---|---|
261QF0400X | Clinic/center - Federally Qualified Health Center (fqhc) | (* (Not Available)) | Primary |
Provider Name | Jorge R Andrade |
---|---|
Provider Type | Practitioner - Obstetrics/gynecology |
Provider Identifiers | NPI Number: 1619973914 PECOS PAC ID: 3274523253 Enrollment ID: I20040512001615 |
Provider Name | Surendranath P Ekanayake |
---|---|
Provider Type | Practitioner - Obstetrics/gynecology |
Provider Identifiers | NPI Number: 1831175173 PECOS PAC ID: 6709869019 Enrollment ID: I20040609000184 |
Provider Name | Raymond Ernst Banfer |
---|---|
Provider Type | Practitioner - Family Practice |
Provider Identifiers | NPI Number: 1093714057 PECOS PAC ID: 7113993478 Enrollment ID: I20040908000655 |
Provider Name | Corrine L Lamm |
---|---|
Provider Type | Practitioner - Nurse Practitioner |
Provider Identifiers | NPI Number: 1407894363 PECOS PAC ID: 5799748679 Enrollment ID: I20041111000216 |
Provider Name | Terry E Harvey |
---|---|
Provider Type | Practitioner - Nurse Practitioner |
Provider Identifiers | NPI Number: 1225079098 PECOS PAC ID: 0941206536 Enrollment ID: I20061004000232 |
Provider Name | Michele Nmi Kennedy |
---|---|
Provider Type | Practitioner - Family Practice |
Provider Identifiers | NPI Number: 1275600504 PECOS PAC ID: 1153424585 Enrollment ID: I20070305000765 |
Provider Name | Jeannette Lois Sweitzer |
---|---|
Provider Type | Practitioner - Nurse Practitioner |
Provider Identifiers | NPI Number: 1053306647 PECOS PAC ID: 4880889054 Enrollment ID: I20101112001037 |
Provider Name | Latasha A Rabsatt |
---|---|
Provider Type | Practitioner - Obstetrics/gynecology |
Provider Identifiers | NPI Number: 1831351899 PECOS PAC ID: 8729233432 Enrollment ID: I20130304000271 |
Provider Name | Liza Dawn Hiles |
---|---|
Provider Type | Practitioner - Family Practice |
Provider Identifiers | NPI Number: 1518296615 PECOS PAC ID: 0244476794 Enrollment ID: I20130429000491 |
Provider Name | Stephanie Nicole Jarvis |
---|---|
Provider Type | Practitioner - Nurse Practitioner |
Provider Identifiers | NPI Number: 1841567856 PECOS PAC ID: 9335314541 Enrollment ID: I20140422000864 |
Provider Name | Jennifer Eckenrode Fitzsimmons |
---|---|
Provider Type | Practitioner - Nurse Practitioner |
Provider Identifiers | NPI Number: 1730517111 PECOS PAC ID: 3577796747 Enrollment ID: I20140424000982 |
Provider Name | Doris Faye Burkey |
---|---|
Provider Type | Practitioner - Nurse Practitioner |
Provider Identifiers | NPI Number: 1144464900 PECOS PAC ID: 8123160645 Enrollment ID: I20141111000373 |
Provider Name | Janell L. Sioma |
---|---|
Provider Type | Practitioner - Nurse Practitioner |
Provider Identifiers | NPI Number: 1598135659 PECOS PAC ID: 8921318254 Enrollment ID: I20151117000364 |
Provider Name | Meghan L Clayton |
---|---|
Provider Type | Practitioner - Nurse Practitioner |
Provider Identifiers | NPI Number: 1861865750 PECOS PAC ID: 8224339791 Enrollment ID: I20151229001412 |
Provider Name | James Doyle Helsley |
---|---|
Provider Type | Practitioner - Family Practice |
Provider Identifiers | NPI Number: 1609904432 PECOS PAC ID: 5496930323 Enrollment ID: I20160426000839 |
Provider Name | Jeffrey Craig Mazique |
---|---|
Provider Type | Practitioner - Internal Medicine |
Provider Identifiers | NPI Number: 1902905300 PECOS PAC ID: 5193893279 Enrollment ID: I20190802000779 |
Provider Name | Sharmila K Matippa |
---|---|
Provider Type | Practitioner - Family Practice |
Provider Identifiers | NPI Number: 1710198494 PECOS PAC ID: 8921141656 Enrollment ID: I20190822001293 |
Provider Name | Rebecca Wiles |
---|---|
Provider Type | Practitioner - Nurse Practitioner |
Provider Identifiers | NPI Number: 1750930293 PECOS PAC ID: 3173957172 Enrollment ID: I20191230000166 |
Provider Name | Chelsea Leigh Shoaf |
---|---|
Provider Type | Practitioner - Nurse Practitioner |
Provider Identifiers | NPI Number: 1639654544 PECOS PAC ID: 0648606079 Enrollment ID: I20200204000689 |
Provider Name | Terri Leann Brown |
---|---|
Provider Type | Practitioner - Nurse Practitioner |
Provider Identifiers | NPI Number: 1518067156 PECOS PAC ID: 3375798598 Enrollment ID: I20200316000042 |
Provider Name | Danielle Ayers Henchey |
---|---|
Provider Type | Practitioner - Nurse Practitioner |
Provider Identifiers | NPI Number: 1841625654 PECOS PAC ID: 9638457856 Enrollment ID: I20200316000268 |
Provider Name | Hannah Mackenzie Metz |
---|---|
Provider Type | Practitioner - Nurse Practitioner |
Provider Identifiers | NPI Number: 1720601313 PECOS PAC ID: 7719307784 Enrollment ID: I20201013000203 |
Provider Name | Stephanie Lee Imler |
---|---|
Provider Type | Practitioner - Nurse Practitioner |
Provider Identifiers | NPI Number: 1881338739 PECOS PAC ID: 6103296439 Enrollment ID: I20230103001979 |
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