Healthcare Provider Details

I. General information

NPI: 1275726580
Provider Name (Legal Business Name): TRI STATE UROLOGIC SERVICES PSC INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/20/2007
Last Update Date: 03/09/2026
Certification Date: 03/09/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

350 THOMAS MORE PKWY STE 200
CRESTVIEW HILLS KY
41017-5460
US

IV. Provider business mailing address

2000 JOSEPH SANKER BLVD
CINCINNATI OH
45212-1979
US

V. Phone/Fax

Practice location:
  • Phone: 859-363-2200
  • Fax:
Mailing address:
  • Phone: 513-841-7400
  • Fax: 513-841-7402

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code363LA2100X
TaxonomyAcute Care Nurse Practitioner
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License Number
License Number State
# 5
Primary TaxonomyN
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number
License Number State
# 6
Primary TaxonomyN
Taxonomy Code332900000X
TaxonomyNon-Pharmacy Dispensing Site
License Number26192
License Number StateKY
# 7
Primary TaxonomyY
Taxonomy Code208800000X
TaxonomyUrology Physician
License Number
License Number State

VIII. Authorized Official

Name: DANIEL SCHRAFF
Title or Position: CHIEF FINANCIAL OFFICER
Credential:
Phone: 614-339-3998