Provider Demographics
NPI:1356508329
Name:ST LUKE TRISTATE WEIGHTLOSS CENTER
Entity Type:Organization
Organization Name:ST LUKE TRISTATE WEIGHTLOSS CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:
Authorized Official - First Name:THOMAS
Authorized Official - Middle Name:
Authorized Official - Last Name:SONNANSTINE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:859-212-4625
Mailing Address - Street 1:7380 TURFWAY RD
Mailing Address - Street 2:
Mailing Address - City:FLORENCE
Mailing Address - State:KY
Mailing Address - Zip Code:41042-1355
Mailing Address - Country:US
Mailing Address - Phone:859-212-4625
Mailing Address - Fax:859-212-4638
Practice Address - Street 1:7380 TURFWAY RD
Practice Address - Street 2:
Practice Address - City:FLORENCE
Practice Address - State:KY
Practice Address - Zip Code:41042-1355
Practice Address - Country:US
Practice Address - Phone:859-212-4625
Practice Address - Fax:859-212-4638
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-05-19
Last Update Date:2008-05-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208600000XAllopathic & Osteopathic PhysiciansSurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY9234OtherMEDICARE GROUP
KY65915621Medicaid