Tri-State Pediatrics

Primary specialty

SpecialistTaxonomy code 174400000X

License

02639 Issued in KY

Legal business name

TRI-STATE PEDIATRICS

Practice address

900 Saint Christopher Dr
Building 4 Suite 101
Ashland, KY 41101-7090

Phone

(606) 836-0919

Fax

(606) 836-2847

NPI assigned

Oct 18, 2006

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Mrs. Michelle Elizabeth Sisler

Title

Billing Clerk

Phone

(606) 836-0919

Specialties & licenses 3

Addresses

Other identifiers 8

Locations

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1161129600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1013098904",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "900 SAINT CHRISTOPHER DR",
            "address_2": "BUILDING 4 SUITE 101",
            "city": "ASHLAND",
            "state": "KY",
            "postal_code": "411017090",
            "telephone_number": "606-836-0919",
            "fax_number": "606-836-2847"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "900 SAINT CHRISTOPHER DR",
            "address_2": "BUILDING 4 SUITE 101",
            "city": "ASHLAND",
            "state": "KY",
            "postal_code": "411017090",
            "telephone_number": "606-836-0919",
            "fax_number": "606-836-2847"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "TRI-STATE PEDIATRICS",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-10-18",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "SISLER",
        "authorized_official_first_name": "MICHELLE",
        "authorized_official_middle_name": "ELIZABETH",
        "authorized_official_title_or_position": "BILLING CLERK",
        "authorized_official_telephone_number": "606-836-0919",
        "authorized_official_name_prefix": "Mrs."
    },
    "taxonomies": [
        {
            "code": "174400000X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Specialist",
            "state": "KY",
            "license": "25781",
            "primary": false
        },
        {
            "code": "174400000X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Specialist",
            "state": "KY",
            "license": "02639",
            "primary": true
        },
        {
            "code": "174400000X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Specialist",
            "state": "KY",
            "license": "38597",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "64011059",
            "state": "KY"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "KY LICENSE",
            "identifier": "02639",
            "state": "KY"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "KY LICENSE",
            "identifier": "38597",
            "state": "KY"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "64066384",
            "state": "KY"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "2271429",
            "state": "OH"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "0665310",
            "state": "OH"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "KY LICENSE",
            "identifier": "25781",
            "state": "KY"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "64257819",
            "state": "KY"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Tri-State Family Medicine, PSC
• Tri-State Hem-Onc PSC
• Tri-State Mobility, LLC
• Tri-State Ophthalmology Associates PSC
• Tri-State Oral & Facial Surgery
• Tri-State Psychological Services, PLLC
• Tri-State Pulmonary Assoc PSC
• Tri-State Radiology, PSC
• Tri-State Stairlifts & Mobility Equipment
• Tri-State Vascular Group, PSC

• Specialist in Ashland, KY
• Providers in Ashland, KY by specialty
• Specialist in Kentucky

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 22, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.