Provider Demographics
NPI:1700823275
Name:TRI-STATE RADIOLOGY, PSC
Entity Type:Organization
Organization Name:TRI-STATE RADIOLOGY, PSC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:GROUP PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:CANDY
Authorized Official - Middle Name:
Authorized Official - Last Name:BOYKIN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:606-327-4633
Mailing Address - Street 1:PO BOX 2408
Mailing Address - Street 2:
Mailing Address - City:ASHLAND
Mailing Address - State:KY
Mailing Address - Zip Code:41105-2408
Mailing Address - Country:US
Mailing Address - Phone:606-327-4633
Mailing Address - Fax:
Practice Address - Street 1:2201 LEXINGTON AVE
Practice Address - Street 2:KINGS DAUGHTER MEDICAL CENTER
Practice Address - City:ASHLAND
Practice Address - State:KY
Practice Address - Zip Code:41101-2843
Practice Address - Country:US
Practice Address - Phone:606-833-5741
Practice Address - Fax:859-223-2732
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-01
Last Update Date:2007-11-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic RadiologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY65927279Medicaid
DA3936Medicare PIN