Provider Demographics
NPI:1760609887
Name:TRI-STATE NEUROSURGICAL INC
Entity Type:Organization
Organization Name:TRI-STATE NEUROSURGICAL INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRACTICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:CHRISTOPHER
Authorized Official - Middle Name:
Authorized Official - Last Name:SNEED
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:812-477-0900
Mailing Address - Street 1:350 W COLUMBIA ST
Mailing Address - Street 2:STE 350
Mailing Address - City:EVANSVILLE
Mailing Address - State:IN
Mailing Address - Zip Code:47710-5610
Mailing Address - Country:US
Mailing Address - Phone:812-477-0900
Mailing Address - Fax:812-477-0099
Practice Address - Street 1:350 W COLUMBIA ST
Practice Address - Street 2:STE 350
Practice Address - City:EVANSVILLE
Practice Address - State:IN
Practice Address - Zip Code:47710-5610
Practice Address - Country:US
Practice Address - Phone:812-477-0900
Practice Address - Fax:812-477-0099
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-19
Last Update Date:2008-06-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207T00000XAllopathic & Osteopathic PhysiciansNeurological SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN100242420AMedicaid
IN100242420BMedicaid
IN100242420BMedicaid