Healthcare Provider Details

I. General information

NPI: 1215122353
Provider Name (Legal Business Name): TRI-STATE DIABETES AND ENDOCRINOLOGY PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/12/2007
Last Update Date: 12/03/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2301 LEXINGTON AVE STE 220
ASHLAND KY
41101-2873
US

IV. Provider business mailing address

2301 LEXINGTON AVE STE 220
ASHLAND KY
41101-2873
US

V. Phone/Fax

Practice location:
  • Phone: 606-327-0055
  • Fax: 606-327-0054
Mailing address:
  • Phone: 606-327-0055
  • Fax: 606-327-0054

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code174400000X
TaxonomySpecialist
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code207RE0101X
TaxonomyEndocrinology, Diabetes & Metabolism Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. JAMAL MERHY
Title or Position: PRESIDENT
Credential: MD
Phone: 606-327-0055