TRI-STATE FAMILY HEALTHCARE
NPI 1649370719
Clinic/Center - Rural Health in Middlesboro, KY

Active since September 25, 2006CLIA 18D1011610 · Waiver
3503 CUMBERLAND AVE, MIDDLESBORO, KY 40965(606) 242-3100(606) 242-3984 Get Directions Write a Review

NPPES record last updated: January 31, 2020. Verified against the NPPES registry weekly; last sync: August 02, 2026.

Record update history: Jan 31, 2020, Oct 17, 2018, Aug 21, 2017 and 1 more (4 updates tracked since 2017).

About Tri-state Family Healthcare NPPES

Official registry information on file with the National Plan and Provider Enumeration System.

TRI-STATE FAMILY HEALTHCARE (NPI 1649370719) is a healthcare organization registered as a rural health in Middlesboro, Kentucky and active in the NPI registry since September 2006. The organization holds a CLIA Waiver certificate valid through June 17, 2027 and lists Larry B Roark, Nurse Practitioner/owner, as its authorized official.

NPPES Registry Identity

NPI1649370719
Entity TypeOrganization
Primary Taxonomy261QR1300X
Legal Business NameTRI STATE MEDICAL CLINIC INC
Location Address3503 CUMBERLAND AVEMiddlesboro, KY 40965-2611
Mailing AddressPo Box 217Middlesboro, KY 40965-0217 · (606) 242-3100 · Fax (606) 242-3984
Fax(606) 242-3984
Organization SubpartNo
Authorized OfficialLarry B RoarkNurse Practitioner/owner · (606) 242-3100
Enumeration DateSeptember 25, 2006
Last NPPES UpdateJanuary 31, 20204 updates tracked since enumeration
NPI 1649370719 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses 2

Primary SpecialtyClinic/Center · Rural HealthAmbulatory Health Care Facilities
Taxonomy Code261QR1300X
Also ListedNurse Practitioner · FamilyTaxonomy 363LF0000X
3503 CUMBERLAND AVE, Middlesboro, KY 40965

Other Names 1

Doing Business AsTri-state Family Healthcare

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 18D1011610

Tri State Medical Clinic · Middlesboro, KY
Active · expires Jun 17, 2027
CLIA Number18D1011610
Laboratory TypePhysician Office
Certificate Effective DateJune 18, 2025
Certificate Expiration DateJune 17, 2027
Laboratory DirectorLarry B. Roark
Laboratory Phone(606) 242-3100
Laboratory LocationTri State Medical Clinic3503 Cumberland Avenue, Middlesboro, KY 40965
CLIA data matches this NPI record on: Address Name Phone
This certificate is issued to a laboratory to perform only waived tests.

Other Providers at the Same Location NPPES 4

Providers registered at the same practice address, or within the immediate area, according to the NPPES registry.

General Practice
3503 CUMBERLAND AVE
MIDDLESBORO, KY 40965
Nurse Practitioner (Family)
3503 CUMBERLAND AVE
MIDDLESBORO, KY 40965
General Practice
3503 CUMBERLAND AVE
MIDDLESBORO, KY 40965
Surgery
3503 CUMBERLAND AVE
MIDDLESBORO, KY 40965

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 Clinic Inc's NPI number?

The NPI number for Tri State Medical Clinic Inc is 1649370719. It was assigned to this organization in the NPPES registry on September 25, 2006. The provider is doing business as Tri-State Family Healthcare.

Where is Tri State Medical Clinic Inc located?

Tri State Medical Clinic Inc is located at 3503 Cumberland Ave, Middlesboro, KY 40965. The listed phone number is (606) 242-3100.

What is Tri State Medical Clinic Inc's specialty?

The primary specialty registered for this NPI is Clinic/Center, specializing in Rural Health, with taxonomy code 261QR1300X.

Does Tri State Medical Clinic Inc hold a CLIA laboratory certificate?

Yes. A Certificate of Waiver (number 18D1011610) is associated with this NPI, valid through June 17, 2027. CLIA certificates authorize laboratory testing under the federal Clinical Laboratory Improvement Amendments program.

What insurance does Tri State Medical Clinic Inc accept?

Health plans from Ambetter Health, Ambetter from Buckeye Health Plan, Ambetter from Home State Health and Ambetter of Tennessee list Tri State Medical Clinic Inc 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 Clinic Inc was last updated on January 31, 2020. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 6 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.