Organization
TRI-STATE TELEMED LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. SHANNON MAXEY M.D. (MEDICAL DIRECTOR)
(304) 208-5978
Entity
Organization
Contact information
Practice address
178 PRIVATE ROAD 19423, SOUTH POINT, OH 45680-8831
(304) 208-5978
Mailing address
620 PRIVATE ROAD 19423, SOUTH POINT, OH 45680-9019
(304) 208-5978
Taxonomy
Speciality
Code
Description
License number
State
208D00000X
General Practice Physician
Primary
48537
KY
363L00000X
Nurse Practitioner
1121101
KY
Other
Enumeration date
12/02/2015
Last updated
12/02/2015
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