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General NPI Number Information
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NPI Number | 1275726580
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Entity Type | Organization
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Legal Business Name | TRI STATE UROLOGIC SERVICES PSC INC
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Dates
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Enumeration Date | 08/20/2007
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Last Update Date | 04/02/2024
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Provider Practice Location Address
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Address Line | 350 THOMAS MORE PKWY STE 200
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City | CRESTVIEW HILLS
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State | KY
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Zip | 41017-5460
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Country | US
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Telephone | 859-363-2200
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Fax |
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Provider Business Mailing Address
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Address Line | 2000 JOSEPH SANKER BLVD
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City | CINCINNATI
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State | OH
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Zip | 45212-1979
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Country | US
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Telephone | 513-841-7400
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Fax | 513-841-7402
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Authorized Official
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Title or Position | CHIEF FINANCIAL OFFICER
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Name | DANIEL SCHRAFF
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Credential |
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Telephone | 614-339-3998
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 332900000X
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Taxonomy Name | Non-Pharmacy Dispensing Site
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License Number | 26192
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License Number State | KY
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Taxonomy #2
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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 #3
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Taxonomy Code | 363LA2100X
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Taxonomy Name | Acute Care Nurse Practitioner
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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 | 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 #5
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Taxonomy Code | 367500000X
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Taxonomy Name | Certified Registered Nurse Anesthetist
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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 | 208800000X
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Taxonomy Name | Urology Physician
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License Number |
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License Number State |
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