# TRI-STATE ALLERGY, INC

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1386786796
- **Authorized official:** DR. MATTHEW C WILSON MD (PRESIDENT)
- **Authorized official phone:** (304) 529-6100

## Contact information

- **Practice address:** 2301 LEXINGTON AVE STE 105, ASHLAND, KY 41101-2807
- **Practice address phone:** (304) 529-6100
- **Practice address fax:** (304) 529-0229
- **Mailing address:** 1001 20TH ST, HUNTINGTON, WV 25703-2019
- **Mailing address phone:** (304) 529-6100
- **Mailing address fax:** (304) 529-0229

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 207KA0200X | Allergy Physician | — | NULL | Yes |
| 207KA0200X | Allergy Physician | — | — | Yes |

## Other

- **Enumeration date:** 02/13/2007
- **Last updated:** 09/05/2014

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 05 | — | 64694763 | — | KY |
| 05 | — | 64698772 | — | KY |
| 05 | — | 65930083 | — | KY |