Healthcare Provider Details

I. General information

NPI: 1013183698
Provider Name (Legal Business Name): TRI-STATE PAIN MANAGEMENT SERVICE INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/05/2008
Last Update Date: 12/15/2020
Certification Date: 12/15/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7520 STATE RD MERCY ANDERSON AMBULATORY
CINCINNATI OH
45255-2439
US

IV. Provider business mailing address

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

V. Phone/Fax

Practice location:
  • Phone: 859-341-7246
  • Fax: 859-341-7867
Mailing address:
  • Phone: 513-624-7525
  • Fax: 513-624-0578

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: JEWELL ASHLEY
Title or Position: OFFICE MANAGER
Credential:
Phone: 513-624-7525