1083807093 NPI number — TRI STATE UROLOGIC SERVICES PSC INC

Table of content: KIMBERLY SUE STEVENS LMHC (NPI 1235766999)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1083807093 NPI number — TRI STATE UROLOGIC SERVICES PSC INC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
TRI STATE UROLOGIC SERVICES PSC INC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
6
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1083807093
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
01/11/2017
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2000 JOSEPH E SANKER BLVD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
CINCINNATI
Provider Business Mailing Address State Name:
OH
Provider Business Mailing Address Postal Code:
45212-1979
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
513-841-7400
Provider Business Mailing Address Fax Number:
513-841-7402

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
605 WILSON CREEK RD
Provider Second Line Business Practice Location Address:
SUITE 01
Provider Business Practice Location Address City Name:
LAWRENCEBURG
Provider Business Practice Location Address State Name:
IN
Provider Business Practice Location Address Postal Code:
47025-2506
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
859-363-2200
Provider Business Practice Location Address Fax Number:
859-363-2201
Provider Enumeration Date:
08/22/2007

Additional Information

Authorized Official

Authorized Official Last Name:
WALZ
Authorized Official First Name:
EARL
Authorized Official Middle Name:
L
Authorized Official Title or Position:
CEO
Authorized Official Telephone Number:
513-841-7400

Provider Taxonomy Codes

  • Taxonomy code: 208800000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 200091770A , issued by the state of ( IN ) . This identifiers is of the category "MEDICAID".
  • Identifier: DN9528 . This is a "RAIROAD MEDICARE" identifier , issued by the state of ( IN ) . This identifiers is of the category "OTHER".




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