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General NPI Number Information
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NPI Number | 1073501003
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Entity Type | Organization
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Legal Business Name | TRI-STATE ORTHOPAEDIC SURGEONS, INC.
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Dates
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Enumeration Date | 10/13/2005
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Last Update Date | 10/04/2019
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Provider Practice Location Address
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Address Line | 225 CROSSLAKE DR
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City | EVANSVILLE
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State | IN
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Zip | 47715-8198
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Country | US
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Telephone | 812-477-1558
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Fax |
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Provider Business Mailing Address
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Address Line | 225 CROSSLAKE DR
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City | EVANSVILLE
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State | IN
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Zip | 47715-8198
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Country | US
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Telephone | 812-477-1558
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Fax |
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Authorized Official
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Title or Position | CEO
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Name | MR. PHILIP RAWLEY
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Credential | MBA
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Telephone | 812-477-1558
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208100000X
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Taxonomy Name | Physical Medicine & Rehabilitation Physician
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 213E00000X
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Taxonomy Name | Podiatrist
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 213ES0103X
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Taxonomy Name | Foot & Ankle Surgery Podiatrist
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License Number |
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License Number State |
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Taxonomy #4
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Taxonomy Code | 332B00000X
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Taxonomy Name | Durable Medical Equipment & Medical Supplies
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License Number |
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License Number State |
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Taxonomy #5
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Taxonomy Code | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number |
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License Number State |
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Taxonomy #6
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Taxonomy Code | 363AM0700X
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Taxonomy Name | Medical Physician Assistant
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License Number |
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License Number State |
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Taxonomy #7
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Taxonomy Code | 363L00000X
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Taxonomy Name | Nurse Practitioner
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License Number |
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License Number State |
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Taxonomy #8
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Taxonomy Code | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number |
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License Number State |
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Taxonomy #9
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Taxonomy Code | 207X00000X
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Taxonomy Name | Orthopaedic Surgery Physician
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License Number | 50000637A
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License Number State | IN
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