Provider Demographics
NPI:1578541546
Name:TRI STATE HEALTH SYSTEMS
Entity Type:Organization
Organization Name:TRI STATE HEALTH SYSTEMS
Other - Org Name:PRIMEMED PLUS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:BUSINESS MANAGER PHYSICIAN SERVICES
Authorized Official - Prefix:
Authorized Official - First Name:KELLY
Authorized Official - Middle Name:
Authorized Official - Last Name:BERNENS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:513-559-2891
Mailing Address - Street 1:DEPT 1044
Mailing Address - Street 2:
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45263-0001
Mailing Address - Country:US
Mailing Address - Phone:513-557-3330
Mailing Address - Fax:513-557-3347
Practice Address - Street 1:415 STRAIGHT ST
Practice Address - Street 2:
Practice Address - City:CINCINNATI
Practice Address - State:OH
Practice Address - Zip Code:45219-1060
Practice Address - Country:US
Practice Address - Phone:513-559-2580
Practice Address - Fax:513-559-2596
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-01-09
Last Update Date:2009-02-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0108136Medicaid
IN200067680BMedicaid
KY65926040Medicaid
IN200067680AMedicaid
OH9264371Medicare PIN
OH0108136Medicaid
OHCC1350Medicare PIN
OH9286562Medicare PIN
OH9312041Medicare PIN
OH9264111Medicare PIN
KY65926040Medicaid
OH9269021Medicare PIN
IN200067680AMedicaid
OHCD4421Medicare PIN
IN200067680BMedicaid
OHCC5409Medicare PIN
OH9264261Medicare PIN
KY8585Medicare PIN