Healthcare Provider Details

I. General information

NPI: 1891731261
Provider Name (Legal Business Name): TRI-STATE PULMONARY ASSOCIATES, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/22/2006
Last Update Date: 08/23/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2123 AUBURN AVE SUITE 401
CINCINNATI OH
45219-2906
US

IV. Provider business mailing address

2123 AUBURN AVE SUITE 401
CINCINNATI OH
45219-2906
US

V. Phone/Fax

Practice location:
  • Phone: 513-241-5489
  • Fax: 513-241-9206
Mailing address:
  • Phone: 513-241-5489
  • Fax: 513-241-9206

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RC0200X
TaxonomyCritical Care Medicine (Internal Medicine) Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code207RP1001X
TaxonomyPulmonary Disease Physician
License Number
License Number State

VIII. Authorized Official

Name: MS. MARILYN J ORR
Title or Position: PRACTICE MANAGER/ADMINISTRATOR
Credential:
Phone: 513-241-5489