Healthcare Provider Details

I. General information

NPI: 1649726142
Provider Name (Legal Business Name): TRI STATE MEDICARE PROVIDERS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/25/2016
Last Update Date: 08/25/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2571 LAFEUILLE AVE
CINCINNATI OH
45211-8200
US

IV. Provider business mailing address

2571 LAFEUILLE AVE
CINCINNATI OH
45211-8200
US

V. Phone/Fax

Practice location:
  • Phone: 513-836-1000
  • Fax: 888-527-4411
Mailing address:
  • Phone: 513-836-1000
  • Fax: 888-527-4411

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code251C00000X
TaxonomyDevelopmentally Disabled Services Day Training Agency
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code251J00000X
TaxonomyNursing Care Agency
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code253Z00000X
TaxonomyIn Home Supportive Care Agency
License Number
License Number State
# 5
Primary TaxonomyN
Taxonomy Code347C00000X
TaxonomyPrivate Vehicle
License Number
License Number State

VIII. Authorized Official

Name: MICHAEL EALY
Title or Position: MEMBER
Credential:
Phone: 513-349-7494