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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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