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General NPI Number Information
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NPI Number | 1790975951
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Entity Type | Organization
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Legal Business Name | TRI-STATE SURGICAL CONSULTANTS INC
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Dates
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Enumeration Date | 07/25/2007
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Last Update Date | 07/25/2007
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Provider Practice Location Address
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Address Line | 2123 AUBURN AVE STE 420
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City | CINCINNATI
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State | OH
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Zip | 45219-2906
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Country | US
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Telephone | 513-421-4504
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Fax | 513-421-4507
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Provider Business Mailing Address
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Address Line | 2123 AUBURN AVE STE 420
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City | CINCINNATI
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State | OH
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Zip | 45219-2906
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Country | US
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Telephone | 513-421-4504
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Fax | 513-421-4507
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Authorized Official
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Title or Position | OWNER
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Name | DR. MARTIN B POPP
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Credential | M.D.
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Telephone | 513-421-4504
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2086X0206X
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Taxonomy Name | Surgical Oncology Physician
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License Number | 35-03-1878P
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License Number State | OH
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