Healthcare Provider Details

I. General information

NPI: 1790975951
Provider Name (Legal Business Name): TRI-STATE SURGICAL CONSULTANTS INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/25/2007
Last Update Date: 07/25/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2123 AUBURN AVE STE 420
CINCINNATI OH
45219-2906
US

IV. Provider business mailing address

2123 AUBURN AVE STE 420
CINCINNATI OH
45219-2906
US

V. Phone/Fax

Practice location:
  • Phone: 513-421-4504
  • Fax: 513-421-4507
Mailing address:
  • Phone: 513-421-4504
  • Fax: 513-421-4507

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2086X0206X
TaxonomySurgical Oncology Physician
License Number35-03-1878P
License Number StateOH

VIII. Authorized Official

Name: DR. MARTIN B POPP
Title or Position: OWNER
Credential: M.D.
Phone: 513-421-4504