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Organization
TRI-STATE VASCULAR GROUP, PSC
Active
Organization
TRI-STATE VASCULAR GROUP, PSC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. OMRAN RIAD ABUL-KHOUDOUD M.D. (PRESIDENT/VASCULAR SURGEON)
(606) 326-1675
Entity
Organization
Contact information
Practice address
2301 LEXINGTON AVE, SUITE 230, ASHLAND, KY 41101-2873
(606) 326-1675
(606) 326-1436
Mailing address
PO BOX 149, ASHLAND, KY 41105-0149
(606) 326-1675
(606) 326-1436
Taxonomy
Speciality
Code
Description
License number
State
174400000X
Specialist
Primary
40007
KY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000000484792
BLUE CROSS BLUE SHIELD
KY
05
—
2645436
—
OH
05
—
65945495
—
KY
01
—
7499265
AETNA
KY
01
—
DF0183
MEDICARE RR
KY
Enumeration date
06/02/2006
Last updated
04/20/2008
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