TRI STATE MEDICAL CENTER PLLC
NPI 1073390944
Nurse Practitioner in Belle Fourche, SD
About Tri State Medical Center Pllc NPPES
Official registry information on file with the National Plan and Provider Enumeration System.
TRI STATE MEDICAL CENTER PLLC (NPI 1073390944) is a healthcare organization registered as a nurse practitioner in Belle Fourche, South Dakota and active in the NPI registry since September 2023. The organization holds a CLIA Waiver certificate valid through October 18, 2027 and lists Vanessa Kudlock, Owner, as its authorized official.
NPPES Registry Identity
Specialties & Licenses
Other Names 1
Accepted Insurance
CLIA Laboratory Certificates CMS CLIA
Laboratory certificates issued under the Clinical Laboratory Improvement Amendments (CLIA) program, which sets federal quality standards for human laboratory testing in the United States. There is no official CMS crosswalk between CLIA and NPI numbers; these certificates are associated with this NPI by matching facility names, locations and phone numbers in the CMS CLIA registry.
Certificate of Waiver 43D2292092
Tri State Medical Center PLLC · Belle Fourche, SDOther Providers at the Same Location NPPES 2
Providers registered at the same practice address, or within the immediate area, according to the NPPES registry.
Frequently Asked Questions NPPES & CMS
Common questions about this NPI record, answered from the official NPPES registry and CMS datasets shown on this page.
What is Tri State Medical Center PLLC's NPI number?
The NPI number for Tri State Medical Center PLLC is 1073390944. It was assigned to this organization in the NPPES registry on September 13, 2023.
Where is Tri State Medical Center PLLC located?
Tri State Medical Center PLLC is located at 2398 5th Ave Ste 101, Belle Fourche, SD 57717. The listed phone number is (605) 645-2064.
What is Tri State Medical Center PLLC's specialty?
The primary specialty registered for this NPI is Nurse Practitioner with taxonomy code 363L00000X.
Does Tri State Medical Center PLLC hold a CLIA laboratory certificate?
Yes. A Certificate of Waiver (number 43D2292092) is associated with this NPI, valid through October 18, 2027. CLIA certificates authorize laboratory testing under the federal Clinical Laboratory Improvement Amendments program.
What insurance does Tri State Medical Center PLLC accept?
Health plans from Avera Health Plans and Medica list Tri State Medical Center PLLC as in-network in at least one marketplace plan. Coverage varies by plan and year; verify with the insurer or the provider before a visit.
When was this NPI record last updated?
The NPPES record for Tri State Medical Center PLLC was last updated on January 11, 2024. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 2 years ago. If this record has changed at CMS more recently, you can request an on-demand re-check against the live CMS registry, directly from this page.
# Tri State Medical Center Pllc · NPI 1073390944
Nurse Practitioner organization in Belle Fourche, South Dakota. Organization record, active in the CMS NPPES registry since September 13, 2023.
## Identity
- **NPI:** 1073390944 (Entity type: Organization)
- **Enumerated:** September 13, 2023
- **Primary specialty:** Nurse Practitioner · taxonomy 363L00000X
- **Organization subpart:** No
- **Authorized official:** Vanessa Kudlock, OWNER
## Practice location
- **Address:** 2398 5TH AVE STE 101, Belle Fourche, SD 57717-2340
- **Phone:** (605) 645-2064
## Record status
- **NPPES last updated:** January 11, 2024
- **CLIA laboratory certificates:** 1 on file
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Source: [NPI Profile](https://npiprofile.com/npi/1073390944) · Data from the CMS NPPES public registry.