Tri-State Telemed LLC

Primary specialty

General Practice PhysicianTaxonomy code 208D00000X

License

48537 Issued in KY

Legal business name

TRI-STATE TELEMED LLC

Practice address

178 Private Road 19423
South Point, OH 45680-8831

Phone

(304) 208-5978

NPI assigned

Dec 2, 2015

Organization subpart

No

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

Authorized official

Name

Dr. Shannon Maxey, M.D.

Title

Medical Director

Phone

(304) 208-5978

Specialties & licenses 2

Addresses

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

{
    "created_epoch": "1449014400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1449014400000",
    "number": "1093180903",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "620 PRIVATE ROAD 19423",
            "city": "SOUTH POINT",
            "state": "OH",
            "postal_code": "456809019",
            "telephone_number": "304-208-5978"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "178 PRIVATE ROAD 19423",
            "city": "SOUTH POINT",
            "state": "OH",
            "postal_code": "456808831",
            "telephone_number": "304-208-5978"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "TRI-STATE TELEMED LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2015-12-02",
        "last_updated": "2015-12-02",
        "status": "A",
        "authorized_official_last_name": "MAXEY",
        "authorized_official_first_name": "SHANNON",
        "authorized_official_title_or_position": "MEDICAL DIRECTOR",
        "authorized_official_telephone_number": "304-208-5978",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "208D00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "General Practice",
            "state": "KY",
            "license": "48537",
            "primary": true
        },
        {
            "code": "363L00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Nurse Practitioner",
            "state": "KY",
            "license": "1121101",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• General Practice Physician in South Point, OH
• Providers in South Point, OH by specialty
• General Practice Physician in Ohio

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 2, 2015; 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.