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General NPI Number Information
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NPI Number | 1649312083
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Entity Type | Organization
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Legal Business Name | TRI- STATE ALLERGY, INC
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Dates
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Enumeration Date | 02/13/2007
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 3752 TEAYS VALLEY RD STE 3
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City | HURRICANE
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State | WV
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Zip | 25526-9705
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Country | US
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Telephone | 304-529-6100
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Fax | 304-529-0229
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Provider Business Mailing Address
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Address Line | 1001 20TH ST
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City | HUNTINGTON
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State | WV
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Zip | 25703-2019
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Country | US
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Telephone | 304-529-6100
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Fax | 304-529-0229
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. MATTHEW C WILSON
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Credential | MD
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Telephone | 304-529-6100
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207KA0200X
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Taxonomy Name | Allergy Physician
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License Number |
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License Number State |
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