Healthcare Provider Details

I. General information

NPI: 1508190794
Provider Name (Legal Business Name): TRI-STATE PAIN MANAGEMENT SERVICE INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/22/2009
Last Update Date: 09/22/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8250 KENWOOD CROSSING WAY
CINCINNATI OH
45236-3668
US

IV. Provider business mailing address

# L-6067
CINCINNATI OH
45270-0001
US

V. Phone/Fax

Practice location:
  • Phone: 859-341-7246
  • Fax: 859-341-7867
Mailing address:
  • Phone: 859-341-7246
  • Fax: 859-341-7867

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: SAIRAM L ATLURI
Title or Position: PRESIDENT OWNER
Credential: MD
Phone: 859-341-7246