Provider Demographics
NPI:1346219839
Name:TRI-STATE ANESTHESIOLOGY, PSC
Entity Type:Organization
Organization Name:TRI-STATE ANESTHESIOLOGY, PSC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:SRIRAM
Authorized Official - Middle Name:K
Authorized Official - Last Name:IYER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:606-327-4000
Mailing Address - Street 1:PO BOX 2558
Mailing Address - Street 2:
Mailing Address - City:ASHLAND
Mailing Address - State:KY
Mailing Address - Zip Code:41105-2558
Mailing Address - Country:US
Mailing Address - Phone:770-237-1089
Mailing Address - Fax:770-237-1124
Practice Address - Street 1:2201 LEXINGTON AVE
Practice Address - Street 2:ANESTHESIA DEPT
Practice Address - City:ASHLAND
Practice Address - State:KY
Practice Address - Zip Code:41101-2843
Practice Address - Country:US
Practice Address - Phone:606-327-4000
Practice Address - Fax:770-237-1124
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-03-16
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY=========OtherTAX ID NUMBER