Provider Demographics
NPI:1285827972
Name:TRI STATE UROLOGIC SERVICES PSC INC
Entity Type:Organization
Organization Name:TRI STATE UROLOGIC SERVICES PSC INC
Other - Org Name:THE UROLOGY GROUP
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:EARL
Authorized Official - Middle Name:L
Authorized Official - Last Name:WALZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:513-841-7400
Mailing Address - Street 1:2000 JOSEPH E SANKER BLVD
Mailing Address - Street 2:
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45212-1979
Mailing Address - Country:US
Mailing Address - Phone:513-841-7400
Mailing Address - Fax:513-841-7402
Practice Address - Street 1:4360 FERGUSON DR STE 100
Practice Address - Street 2:
Practice Address - City:CINCINNATI
Practice Address - State:OH
Practice Address - Zip Code:45245-1683
Practice Address - Country:US
Practice Address - Phone:513-841-7750
Practice Address - Fax:513-841-7751
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-08-25
Last Update Date:2024-04-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208800000XAllopathic & Osteopathic PhysiciansUrologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0276946Medicaid
OHCC2433OtherRAILROAD MEDICARE
OHCC2433OtherRAILROAD MEDICARE
OH0276946Medicaid