MEDICARE: TRI STATE UROLOGIC SERVICES PSC INC

Medicare Provider Information

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

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	332B00000X	Durable Medical Equipment & Medical Supplies
2	208800000X	Urology Physician

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
2	CC2433	OTHER	OH	RAILROAD MEDICARE

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

NPI Number	:	1619200664
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	TRI STATE UROLOGIC SERVICES PSC INC

Provider Business Mailing Address
First Line	:	2000 JOSEPH E SANKER BLVD
Second Line	:
City	:	CINCINNATI
State	:	OH
Zip	:	45212-1979
Country	:	US
Telephone Number	:	513-841-7400
Fax Number	:	513-841-7402

Provider Business Practice Location Address
First Line	:	10220 ALLIANCE RD
Second Line	:
City	:	BLUE ASH
State	:	OH
Zip	:	45242-4710
Country	:	US
Telephone Number	:	513-841-7800
Fax Number	:	513-841-7801

Authorized Official
Title or Position	:	CEO
Name	:	EARL L WALZ
Credential	:
Telephone Number	:	513-841-7400

Provider Enumeration Date	:	09/09/2009
Last Update Date	:	03/09/2026

10274 ALLIANCE RD
BLUE ASH, OH
45242-4710

Practice Phone: 513-891-3093
Practice Fax: 513-891-9947

10220 ALLIANCE RD
BLUE ASH, OH
45242-4710