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Organization
TRI-STATE ALLERGY, INC
Active
Organization
TRI-STATE ALLERGY, INC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. MATTHEW C WILSON MD (PRESIDENT)
(304) 529-6100
Entity
Organization
Contact information
Practice address
2301 LEXINGTON AVE STE 105, ASHLAND, KY 41101-2807
(304) 529-6100
(304) 529-0229
Mailing address
1001 20TH ST, HUNTINGTON, WV 25703-2019
(304) 529-6100
(304) 529-0229
Taxonomy
Speciality
Code
Description
License number
State
207KA0200X
Allergy Physician
Primary
—
NULL
207KA0200X
Allergy Physician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
64694763
—
KY
05
—
64698772
—
KY
05
—
65930083
—
KY
Enumeration date
02/13/2007
Last updated
09/05/2014
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