Healthcare Provider Details

I. General information

NPI: 1326184177
Provider Name (Legal Business Name): TRI-STATE CYTOLOGY LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/29/2007
Last Update Date: 04/21/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

403 10TH ST
KENOVA WV
25530-1446
US

IV. Provider business mailing address

403 10TH ST
KENOVA WV
25530-1446
US

V. Phone/Fax

Practice location:
  • Phone: 304-521-4991
  • Fax: 304-521-2919
Mailing address:
  • Phone: 304-521-4991
  • Fax: 304-521-2919

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code291U00000X
TaxonomyClinical Medical Laboratory
License Number
License Number StateWV

VIII. Authorized Official

Name: MRS. ANGELA LYNETTE GEIS
Title or Position: PRESIDENT
Credential: BS., CT.
Phone: 304-521-4991