Healthcare Provider Details

I. General information

NPI: 1275450389
Provider Name (Legal Business Name): TRI STATE UROLOGIC SERVICES PSC INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/30/2026
Last Update Date: 06/30/2026
Certification Date: 06/30/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

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

IV. Provider business mailing address

PO BOX 738291
DALLAS TX
75373-8291
US

V. Phone/Fax

Practice location:
  • Phone: 859-363-2200
  • Fax: 859-363-2201
Mailing address:
  • Phone: 859-363-2200
  • Fax: 859-363-2201

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208800000X
TaxonomyUrology Physician
License Number
License Number State

VIII. Authorized Official

Name: MICHAEL GALVIN
Title or Position: CEO
Credential:
Phone: 513-841-7400