Provider Demographics
NPI:1609962067
Name:TRI STATE NEUROSCIENCE CENTER INC
Entity Type:Organization
Organization Name:TRI STATE NEUROSCIENCE CENTER INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:ERMA
Authorized Official - Middle Name:
Authorized Official - Last Name:ABBOTT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:304-525-6825
Mailing Address - Street 1:PO BOX 3107
Mailing Address - Street 2:2860 3RD AVE SUITE 10
Mailing Address - City:HUNTINGTON
Mailing Address - State:WV
Mailing Address - Zip Code:25702
Mailing Address - Country:US
Mailing Address - Phone:304-525-6825
Mailing Address - Fax:304-525-0300
Practice Address - Street 1:2860 3RD AVE
Practice Address - Street 2:SUITE 10
Practice Address - City:HUNTINGTON
Practice Address - State:WV
Practice Address - Zip Code:25702
Practice Address - Country:US
Practice Address - Phone:304-525-6825
Practice Address - Fax:304-525-0300
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-05
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207T00000XAllopathic & Osteopathic PhysiciansNeurological SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0883745OtherMEDICAID