Provider Demographics
NPI:1215122353
Name:TRI-STATE DIABETES AND ENDOCRINOLOGY PLLC
Entity type:Organization
Organization Name:TRI-STATE DIABETES AND ENDOCRINOLOGY PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JAMAL
Authorized Official - Middle Name:
Authorized Official - Last Name:MERHY
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:606-327-0055
Mailing Address - Street 1:2301 LEXINGTON AVE
Mailing Address - Street 2:STE 220
Mailing Address - City:ASHLAND
Mailing Address - State:KY
Mailing Address - Zip Code:41101-2873
Mailing Address - Country:US
Mailing Address - Phone:606-327-0055
Mailing Address - Fax:606-327-0054
Practice Address - Street 1:2301 LEXINGTON AVE
Practice Address - Street 2:STE 220
Practice Address - City:ASHLAND
Practice Address - State:KY
Practice Address - Zip Code:41101-2873
Practice Address - Country:US
Practice Address - Phone:606-327-0055
Practice Address - Fax:606-327-0054
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-09-12
Last Update Date:2019-12-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RE0101XAllopathic & Osteopathic PhysiciansInternal MedicineEndocrinology, Diabetes & MetabolismGroup - Multi-Specialty
No174400000XOther Service ProvidersSpecialistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
DG2468OtherRAILROAD MEDICARE
KY00412Medicare PIN
DG2468OtherRAILROAD MEDICARE