# TRI-STATE ANESTHESIA GROUP PSC

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

## Provider details

- **NPI number:** 1487051538
- **Authorized official:** STACEY C SHY (ADMINISTRATOR)
- **Authorized official phone:** (304) 429-1088

## Contact information

- **Practice address:** 2301 LEXINGTON AVE, SUITE 100, ASHLAND, KY 41101-2873
- **Practice address phone:** (304) 429-1088
- **Practice address fax:** (304) 429-3109
- **Mailing address:** PO BOX 390, HUNTINGTON, WV 25708-0390
- **Mailing address phone:** (304) 429-1088
- **Mailing address fax:** (304) 429-3109

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 207L00000X | Anesthesiology Physician | — | NULL | Yes |
| 207L00000X | Anesthesiology Physician | — | — | Yes |

## Other

- **Enumeration date:** 12/04/2014
- **Last updated:** 12/04/2014