Healthcare Provider Details

I. General information

NPI: 1629831714
Provider Name (Legal Business Name): TRI-STATE NEUROSURGICAL PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/01/2024
Last Update Date: 01/28/2025
Certification Date: 01/28/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4133 GATEWAY BLVD STE 170
NEWBURGH IN
47630-8950
US

IV. Provider business mailing address

PO BOX 1642
EVANSVILLE IN
47706-0043
US

V. Phone/Fax

Practice location:
  • Phone: 812-758-4199
  • Fax:
Mailing address:
  • Phone: 812-758-4199
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code363AS0400X
TaxonomySurgical Physician Assistant
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License Number
License Number State

VIII. Authorized Official

Name: DAVID EGGERS
Title or Position: OWNER
Credential: MD
Phone: 812-758-4199