Tri State Medical Center PLLC
NPI 1073390944ActiveOrganization· Nurse Practitioner· Belle Fourche, SD
Nurse Practitioner in Belle Fourche, South Dakota, registered in NPPES in September 2023. The authorized official on file is Vanessa Kudlock, CNP, Owner. Enrolled in Medicare as part b supplier - clinic/group practice.
Overview
| NPI | 1073390944 |
|---|---|
| Status | Active |
| Entity type | Organization |
| NPI issued | Sep 13, 2023 |
| Last updated in NPPES | Jan 11, 2024 |
| Certified by provider | Jan 11, 2024 |
Specialties and licenses
| Taxonomy | Code | License | State |
|---|---|---|---|
| Nurse Practitioner Primary | 363L00000X | — | — |
Exclusion screening
| List | Result | Details |
|---|---|---|
| HHS-OIG LEIE · Oct 9, 2026 | No match | Checked by NPI and by name + state |
| North Carolina Medicaid · Nov 10, 2026 | No match | — |
| New York OMIG · Nov 10, 2026 | No match | — |
| Ohio Medicaid · Nov 10, 2026 | No match | — |
| Pennsylvania Medicheck · Nov 10, 2026 | No match | — |
| Washington HCA · Nov 10, 2026 | No match | — |
Official OIG search · How matching works ·Bulk check a roster
Medicare
| Enrollment (PECOS) | Enrolled Part B Supplier - Clinic/Group Practice (SD) |
|---|
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