MEDICARE: TRI-STATE NEUROPATHY CENTER LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207Q00000X	Family Medicine Physician

General Provider Information

NPI Number	:	1427356708
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	TRI-STATE NEUROPATHY CENTER LLC

Provider Business Mailing Address
First Line	:	3021 VERNON PL
Second Line	:
City	:	CINCINNATI
State	:	OH
Zip	:	45219-2417
Country	:	US
Telephone Number	:	513-751-6990
Fax Number	:	513-751-7228

Provider Business Practice Location Address
First Line	:	3021 VERNON PL
Second Line	:
City	:	CINCINNATI
State	:	OH
Zip	:	45219-2417
Country	:	US
Telephone Number	:	513-751-6990
Fax Number	:	513-751-7228

Authorized Official
Title or Position	:	OWNER
Name	:	JASON MAURER
Credential	:
Telephone Number	:	513-751-6990

Provider Enumeration Date	:	03/10/2011
Last Update Date	:	07/06/2011

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