Provider Demographics
NPI:1205024916
Name:TRI-STATE CARDIOLOGY ASSOCIATES PSC
Entity Type:Organization
Organization Name:TRI-STATE CARDIOLOGY ASSOCIATES PSC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:JENNY
Authorized Official - Middle Name:
Authorized Official - Last Name:VALLANCE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:740-894-8160
Mailing Address - Street 1:2301 LEXINGTON AVE
Mailing Address - Street 2:STE 320
Mailing Address - City:ASHLAND
Mailing Address - State:KY
Mailing Address - Zip Code:41101
Mailing Address - Country:US
Mailing Address - Phone:740-646-9049
Mailing Address - Fax:
Practice Address - Street 1:2301 LEXINGTON AVE
Practice Address - Street 2:STE 320
Practice Address - City:ASHLAND
Practice Address - State:KY
Practice Address - Zip Code:41101
Practice Address - Country:US
Practice Address - Phone:740-646-9049
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-10-09
Last Update Date:2007-10-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY24576207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
KYC75592Medicare UPIN