Organization
TRI- STATE ALLERGY, INC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. MATTHEW C WILSON MD (PRESIDENT)
(304) 529-6100
Entity
Organization
Contact information
Practice address
3752 TEAYS VALLEY RD STE 3, HURRICANE, WV 25526-9705
(304) 529-6100
(304) 529-0229
Mailing address
1001 20TH ST, HUNTINGTON, WV 25703-2019
(304) 529-6100
(304) 529-0229
Taxonomy
Speciality
Code
Description
License number
State
207KA0200X
Allergy Physician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0044083000
—
WV
05
—
0070510000
—
WV
05
—
L0489556
—
OH
05
—
L0874442
—
OH
Enumeration date
02/13/2007
Last updated
08/22/2020
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