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TRI-STATE HEALING INITIATIVE LLC
NPI 1841984036
Family Medicine in Russell, KY

Active since June 08, 2023CLIA 18D2337759 · Waiver
1619 DIEDERICH BLVD STE D1, RUSSELL, KY 41169(952) 261-7105 Get Directions Write a Review

NPPES record last updated: June 17, 2025. Verified against the NPPES registry weekly; last sync: August 02, 2026.

Record update history: Jun 17, 2025, Jun 8, 2023 (2 updates tracked since 2023).

About Tri-state Healing Initiative Llc NPPES

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

TRI-STATE HEALING INITIATIVE LLC (NPI 1841984036) is a healthcare organization registered as a family medicine in Russell, Kentucky and active in the NPI registry since June 2023. The organization holds a CLIA Waiver certificate valid through January 28, 2028 and lists Bryce Ratliff, Owner, as its authorized official.

NPPES Registry Identity

NPI1841984036
Entity TypeOrganization
Primary Taxonomy207Q00000X
Legal Business NameTRI-STATE HEALING INITIATIVE LLC
Location Address1619 DIEDERICH BLVD STE D1Russell, KY 41169-1778
Mailing Address17 Lackawanna Pl Apt 318Bloomfield, NJ 07003-2954
Phone(952) 261-7105
Organization SubpartNo
Authorized OfficialBryce RatliffOwner · (952) 261-7105
Enumeration DateJune 8, 2023
Last NPPES UpdateJune 17, 20252 updates tracked since enumeration
NPPES CertifiedJune 17, 2025
✔ NPI 1841984036 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtyFamily MedicineAllopathic & Osteopathic Physicians
Taxonomy Code207Q00000X
Definition
Family Medicine is the medical specialty which is concerned with the total health care of the individual and the family. It is the specialty in breadth which integrates the biological, clinical, and behavioral sciences. The scope of family medicine is not limited by age, sex, organ system, or disease entity.
1619 DIEDERICH BLVD STE D1, Russell, KY 41169
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Group Practice 1

Group TaxonomyThis provdier is a business group of one or more individual practitioners, all of who practice with the same area of specialization.193400000X SINGLE SPECIALTY GROUP

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 18D2337759

Tri-State Healing Initiative LLC · Louisville, KY
Active · expires Jan 28, 2028
CLIA Number18D2337759
Laboratory TypePhysician Office
Certificate Effective DateJanuary 29, 2026
Certificate Expiration DateJanuary 28, 2028
Laboratory DirectorMr. Bryce C. Ratliff
Laboratory Phone(952) 261-7105
Laboratory LocationTri-State Healing Initiative LLC2210 Goldsmith Lane Ste -126-1064, Louisville, KY 40218
CLIA data matches this NPI record on: Name Phone
This certificate is issued to a laboratory to perform only waived tests.

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 Healing Initiative LLC's NPI number?

The NPI number for Tri-State Healing Initiative LLC is 1841984036. It was assigned to this organization in the NPPES registry on June 8, 2023.

Where is Tri-State Healing Initiative LLC located?

Tri-State Healing Initiative LLC is located at 1619 Diederich Blvd Ste D1, Russell, KY 41169. The listed phone number is (952) 261-7105.

What is Tri-State Healing Initiative LLC's specialty?

The primary specialty registered for this NPI is Family Medicine with taxonomy code 207Q00000X.

Does Tri-State Healing Initiative LLC hold a CLIA laboratory certificate?

Yes. A Certificate of Waiver (number 18D2337759) is associated with this NPI, valid through January 28, 2028. CLIA certificates authorize laboratory testing under the federal Clinical Laboratory Improvement Amendments program.

When was this NPI record last updated?

The NPPES record for Tri-State Healing Initiative LLC was last updated on June 17, 2025. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 13 months 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.