MEDICARE: TRI STATE MEDICARE PROVIDERS

Medicare Provider Information

Scope of Practice

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

#	Taxonomy Code	Taxonomy
1	253Z00000X	In Home Supportive Care Agency
2	347C00000X	Private Vehicle
3	251C00000X	Developmentally Disabled Services Day Training Agency
4	251J00000X	Nursing Care Agency
5	251E00000X	Home Health Agency

General Provider Information

NPI Number	:	1649726142
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	TRI STATE MEDICARE PROVIDERS

Provider Business Mailing Address
First Line	:	2571 LAFEUILLE AVE
Second Line	:
City	:	CINCINNATI
State	:	OH
Zip	:	45211-8200
Country	:	US
Telephone Number	:	513-836-1000
Fax Number	:	888-527-4411

Provider Business Practice Location Address
First Line	:	2571 LAFEUILLE AVE
Second Line	:
City	:	CINCINNATI
State	:	OH
Zip	:	45211-8200
Country	:	US
Telephone Number	:	513-836-1000
Fax Number	:	888-527-4411

Authorized Official
Title or Position	:	MEMBER
Name	:	MICHAEL EALY
Credential	:
Telephone Number	:	513-349-7494

Provider Enumeration Date	:	08/25/2016
Last Update Date	:	08/25/2016

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Directions to “TRI STATE MEDICARE PROVIDERS ” Practice Location

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