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General NPI Number Information
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NPI Number | 1912729005
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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 | 10/29/2024
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Last Update Date | 10/29/2024
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Provider Practice Location Address
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Address Line | 4746 MONTGOMERY RD
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City | CINCINNATI
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State | OH
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Zip | 45212-2622
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Country | US
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Telephone | 513-841-7400
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 738291
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City | DALLAS
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State | TX
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Zip | 75373-8291
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | MANAGER
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Name | JANIS RUTH OSBORNE
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Credential |
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Telephone | 513-841-7466
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2085R0204X
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Taxonomy Name | Vascular & Interventional Radiology 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 | 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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