Healthcare Provider Details

I. General information

NPI: 1467834267
Provider Name (Legal Business Name): TRI-STATE MOBILITY, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/29/2015
Last Update Date: 11/23/2020
Certification Date: 11/23/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

712 WINCHESTER AVE
ASHLAND KY
41101-7443
US

IV. Provider business mailing address

712 WINCHESTER AVE
ASHLAND KY
41101-7443
US

V. Phone/Fax

Practice location:
  • Phone: 606-329-1344
  • Fax: 606-329-0207
Mailing address:
  • Phone: 606-329-1344
  • Fax: 606-329-0207

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code171WH0202X
TaxonomyHome Modifications Contractor
License Number
License Number State

VIII. Authorized Official

Name: STEVEN LYON
Title or Position: OWNER, SOLE MEMBER
Credential:
Phone: 606-329-1344