Provider Demographics
NPI:1427356708
Name:TRI-STATE NEUROPATHY CENTER LLC
Entity type:Organization
Organization Name:TRI-STATE NEUROPATHY CENTER LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JASON
Authorized Official - Middle Name:
Authorized Official - Last Name:MAURER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:513-751-6990
Mailing Address - Street 1:3021 VERNON PL
Mailing Address - Street 2:
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45219-2417
Mailing Address - Country:US
Mailing Address - Phone:513-751-6990
Mailing Address - Fax:513-751-7228
Practice Address - Street 1:3021 VERNON PL
Practice Address - Street 2:
Practice Address - City:CINCINNATI
Practice Address - State:OH
Practice Address - Zip Code:45219-2417
Practice Address - Country:US
Practice Address - Phone:513-751-6990
Practice Address - Fax:513-751-7228
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-03-10
Last Update Date:2011-07-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty