Larry Brandon Roark TRISTATE MEDICAL CLINIC INC

Address: 2317 Cumberland Ave, Middlesboro, KY 40965-2834
Phone: 6062423100

Larry Brandon Roark (NPI# 1437281649, PAC ID# 6800989195) is a physician enrolled in Centers for Medicare & Medicaid Services (CMS). The primary specialty is NURSE PRACTITIONER.

Physician Overview

Nation Provider ID (NPI) 1437281649
PAC ID by PECOS 6800989195
Professional Enrollment ID I20070831000321
Full Name Larry Brandon Roark
Organization Legal Name TRISTATE MEDICAL CLINIC INC
Address 2317 Cumberland Ave
Middlesboro
KY 40965-2834
Phone Number 6062423100
Gender M
Graduation Year 2006
Primary Specialty NURSE PRACTITIONER
Group Practice PAC ID 5890713424
Accepts Medicare Assignment Y
Report Quality Measures Y

Claims Based Hospital Affiliation

Claim Control Number (CCN) Legal Business Name
180020 MIDDLESBORO APPALACHIAN REGIONAL HEALTHCARE HOSPIT
180021 PINEVILLE COMMUNITY HOSPITAL

Other Locations

Address Phone Organization
2317 Cumberland Ave, Middlesboro, KY 40965-2834 6062423100 TRISTATE MEDICAL CLINIC INC

Organization Information

Organization Legal Name TRISTATE MEDICAL CLINIC INC
Physicians 1

Office Location

Street Address 2317 CUMBERLAND AVE
City MIDDLESBORO
State KY
Zip 40965-2834

Competitor

Search similar physicians

City MIDDLESBORO
Zip Code 40965
Specialty NURSE PRACTITIONER
City + Specialty MIDDLESBORO + NURSE PRACTITIONER

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Dataset Information

Data Provider Centers for Medicare & Medicaid Services (CMS)
Jurisdiction Medicare

This dataset includes 1.12 million groups, individual physicians, and other clinicians currently enrolled in Medicare. Each physician is registered with NPI, PAC ID, full name, specialty, phone, organization, hospital, address, medical school, etc.