Provider Demographics
NPI:1699723775
Name:TRI-STATE FAMILY PRACTICE LLP
Entity type:Organization
Organization Name:TRI-STATE FAMILY PRACTICE LLP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MS
Authorized Official - First Name:BARBARA
Authorized Official - Middle Name:A
Authorized Official - Last Name:TLAMKA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:563-557-5900
Mailing Address - Street 1:1500 DELHI ST
Mailing Address - Street 2:SUITE 4100
Mailing Address - City:DUBUQUE
Mailing Address - State:IA
Mailing Address - Zip Code:52001-6358
Mailing Address - Country:US
Mailing Address - Phone:563-557-5900
Mailing Address - Fax:563-557-5905
Practice Address - Street 1:1500 DELHI ST
Practice Address - Street 2:SUITE 4100
Practice Address - City:DUBUQUE
Practice Address - State:IA
Practice Address - Zip Code:52001-6358
Practice Address - Country:US
Practice Address - Phone:563-557-5900
Practice Address - Fax:563-557-5905
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-04
Last Update Date:2011-06-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes173000000XOther Service ProvidersLegal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA0146019Medicaid
IA55321OtherGROUP BCBS IDENTIFICATION
IA55321Medicare PIN