Provider Demographics
NPI:1659322618
Name:TRI-STATE HEM-ONC PSC
Entity Type:Organization
Organization Name:TRI-STATE HEM-ONC PSC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:KENDALL
Authorized Official - Last Name:GOEBEL
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:606-325-2221
Mailing Address - Street 1:617 23RD ST
Mailing Address - Street 2:SUITE 19
Mailing Address - City:ASHLAND
Mailing Address - State:KY
Mailing Address - Zip Code:41101-2845
Mailing Address - Country:US
Mailing Address - Phone:606-325-2221
Mailing Address - Fax:606-324-1326
Practice Address - Street 1:617 23RD ST
Practice Address - Street 2:SUITE 19
Practice Address - City:ASHLAND
Practice Address - State:KY
Practice Address - Zip Code:41101-2845
Practice Address - Country:US
Practice Address - Phone:606-325-2221
Practice Address - Fax:606-324-1326
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-15
Last Update Date:2010-07-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RH0003XAllopathic & Osteopathic PhysiciansInternal MedicineHematology & OncologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY65925794Medicaid
KYW99128Medicare UPIN
KY5279580001Medicare NSC