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General NPI Number Information
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NPI Number | 1053939074
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Entity Type | Organization
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Legal Business Name | TRI-STATE SURGICAL CENTER, LLC
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Dates
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Enumeration Date | 07/07/2020
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Last Update Date | 07/09/2020
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Provider Practice Location Address
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Address Line | 1006 TAVERN RD
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City | MARTINSBURG
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State | WV
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Zip | 25401-2864
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Country | US
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Telephone | 304-267-0556
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Fax | 304-267-1460
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Provider Business Mailing Address
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Address Line | 1006 TAVERN RD
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City | MARTINSBURG
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State | WV
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Zip | 25401-2864
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Country | US
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Telephone | 304-267-0556
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Fax | 304-267-1460
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Authorized Official
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Title or Position | BILLING/CODING MANAGER
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Name | HILDA LYNN HOFFMASTER
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Credential |
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Telephone | 304-263-5129
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207L00000X
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Taxonomy Name | Anesthesiology Physician
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License Number |
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License Number State |
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