Tri- State Allergy, Inc

Primary specialty

Allergy PhysicianTaxonomy code 207KA0200X

Legal business name

TRI- STATE ALLERGY, INC

Practice address

3752 Teays Valley Rd Ste 3
Hurricane, WV 25526-9705

Phone

(304) 529-6100

Fax

(304) 529-0229

NPI assigned

Feb 13, 2007

Organization subpart

No

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

Authorized official

Name

Dr. Matthew C Wilson, MDNPI 1891726295

Title

President

Phone

(304) 529-6100

Specialties & licenses 1

Addresses

Other identifiers 4

Tax ID family

Tri- State Allergy Inc2 organizations share this tax ID, including this one

Other organizations with this tax ID 1

Organizations that report the same tax identification number in the National Provider Directory.

• Tri-State Allergy, Inc

  • Allergy Physician
  • Huntington, WV
  • NPI 1902906019
  NPD tax ID

Locations

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Matthew C Wilson, MD

  • Allergy Physician
  • Huntington, WV
  • NPI 1891726295
  NPD (past) Authorized official

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

{
    "created_epoch": "1171324800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1649312083",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1001 20TH ST",
            "city": "HUNTINGTON",
            "state": "WV",
            "postal_code": "257032019",
            "telephone_number": "304-529-6100",
            "fax_number": "304-529-0229"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3752 TEAYS VALLEY RD STE 3",
            "city": "HURRICANE",
            "state": "WV",
            "postal_code": "255269705",
            "telephone_number": "304-529-6100",
            "fax_number": "304-529-0229"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "TRI- STATE ALLERGY, INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-02-13",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "WILSON",
        "authorized_official_first_name": "MATTHEW",
        "authorized_official_middle_name": "C",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "304-529-6100",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "207KA0200X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Allergy & Immunology, Allergy",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "L0489556",
            "state": "OH"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "L0874442",
            "state": "OH"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "0044083000",
            "state": "WV"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "0070510000",
            "state": "WV"
        }
    ],
    "endpoints": [],
    "other_names": []
}

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• Allergy Physician in Hurricane, WV
• Providers in Hurricane, WV by specialty
• Allergy Physician in West Virginia

• 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.