Healthcare Provider Details

I. General information

NPI: 1780800516
Provider Name (Legal Business Name): TRI-STATE OCCUPATIONAL MEDICINE, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/18/2007
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

612 6TH AVE
HUNTINGTON WV
25701-2104
US

IV. Provider business mailing address

612 6TH AVE
HUNTINGTON WV
25701-2104
US

V. Phone/Fax

Practice location:
  • Phone: 304-525-4202
  • Fax: 304-525-4231
Mailing address:
  • Phone: 304-525-4202
  • Fax: 304-525-4231

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code202C00000X
TaxonomyIndependent Medical Examiner Physician
License Number
License Number State

VIII. Authorized Official

Name: REGINA ZORNES
Title or Position: OFFICE MANAGER
Credential:
Phone: 304-525-4202