Healthcare Provider Details

I. General information

NPI: 1528316726
Provider Name (Legal Business Name): TRI-STATE PAIN MANAGEMENT SERVICE INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/17/2012
Last Update Date: 03/28/2022
Certification Date: 03/28/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7655 5 MILE RD STE 117
CINCINNATI OH
45230-4326
US

IV. Provider business mailing address

7655 5 MILE RD STE 117
CINCINNATI OH
45230-4326
US

V. Phone/Fax

Practice location:
  • Phone: 513-624-7525
  • Fax: 513-624-0578
Mailing address:
  • Phone: 513-624-7525
  • Fax: 513-624-0578

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208VP0014X
TaxonomyInterventional Pain Medicine Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number
License Number State

VIII. Authorized Official

Name: DR. SAIRAM L ATLURI
Title or Position: PRESIDENT OWNER
Credential: M.D.
Phone: 859-341-7246