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Organization
TRI-STATE PEDIATRICS
Active
Organization
TRI-STATE PEDIATRICS
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. MICHELLE ELIZABETH SISLER (BILLING CLERK)
(606) 836-0919
Entity
Organization
Contact information
Practice address
900 SAINT CHRISTOPHER DR, BUILDING 4 SUITE 101, ASHLAND, KY 41101-7090
(606) 836-0919
(606) 836-2847
Mailing address
900 SAINT CHRISTOPHER DR, BUILDING 4 SUITE 101, ASHLAND, KY 41101-7090
(606) 836-0919
(606) 836-2847
Taxonomy
Speciality
Code
Description
License number
State
174400000X
Specialist
Primary
02639
KY
174400000X
Specialist
25781
KY
174400000X
Specialist
38597
KY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
02639
KY LICENSE
KY
05
—
0665310
—
OH
05
—
2271429
—
OH
01
—
25781
KY LICENSE
KY
01
—
38597
KY LICENSE
KY
05
—
64011059
—
KY
05
—
64066384
—
KY
05
—
64257819
—
KY
Enumeration date
10/18/2006
Last updated
08/22/2020
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