Provider Demographics
NPI:1326184177
Name:TRI-STATE CYTOLOGY LLC
Entity Type:Organization
Organization Name:TRI-STATE CYTOLOGY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MRS
Authorized Official - First Name:ANGELA
Authorized Official - Middle Name:LYNETTE
Authorized Official - Last Name:GEIS
Authorized Official - Suffix:
Authorized Official - Credentials:BS, CT
Authorized Official - Phone:304-521-4991
Mailing Address - Street 1:403 10TH ST
Mailing Address - Street 2:
Mailing Address - City:KENOVA
Mailing Address - State:WV
Mailing Address - Zip Code:25530-1446
Mailing Address - Country:US
Mailing Address - Phone:304-521-4991
Mailing Address - Fax:304-521-2919
Practice Address - Street 1:403 10TH ST
Practice Address - Street 2:
Practice Address - City:KENOVA
Practice Address - State:WV
Practice Address - Zip Code:25530-1446
Practice Address - Country:US
Practice Address - Phone:304-521-4991
Practice Address - Fax:304-521-2919
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-29
Last Update Date:2009-04-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV291U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory
Provider Identifiers
StateIdentifier IDID TypeIssuer
WVD518411Medicare PIN