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NPI Code Detail

MEDICARE: TRI-STATE CLINICAL LABORATORY SERVICES, LLC

MEDICARE: TRI-STATE CLINICAL LABORATORY SERVICES, LLC
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1291U00000XClinical Medical Laboratory

General Provider Information

NPI Number : 1285887190
Entity Type Code : Organization
Provider Name (Legal Business Name) : TRI-STATE CLINICAL LABORATORY SERVICES, LLC
Provider Business Mailing Address
First Line : 1737 TENNESSEE AVE
Second Line :
City : CINCINNATI
State : OH
Zip : 45229-1201
Country : US
Telephone Number : 336-436-5150
Fax Number :
Provider Business Practice Location Address
First Line : 1737 TENNESSEE AVE
Second Line :
City : CINCINNATI
State : OH
Zip : 45229-1201
Country : US
Telephone Number : 336-436-5150
Fax Number :
Authorized Official
Title or Position : DIRECTOR
Name : MR. DON OLENICK
Credential :
Telephone Number : 336-436-5150
Provider Enumeration Date : 10/23/2008
Last Update Date : 12/18/2008

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Directions to “TRI-STATE CLINICAL LABORATORY SERVICES, LLC ” Practice Location

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