Organization
TRI-STATE MRI PTR
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MS. MARY ALICE ROBERTS (ADMINISTRATIVE DIRECTOR)
(304) 522-6674
Entity
Organization
Contact information
Practice address
1802 6TH AVE, HUNTINGTON, WV 25703-1519
(304) 522-6674
(304) 522-4647
Mailing address
PO BOX 494, HUNTINGTON, WV 25709-0494
(304) 522-6674
(304) 522-4647
Taxonomy
Speciality
Code
Description
License number
State
261QM1200X
Magnetic Resonance Imaging (MRI) Clinic/Center
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0036348000
—
WV
05
—
0682677
—
OH
Enumeration date
06/30/2005
Last updated
06/23/2008
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