Provider Demographics
NPI:1790975951
Name:TRI-STATE SURGICAL CONSULTANTS INC
Entity Type:Organization
Organization Name:TRI-STATE SURGICAL CONSULTANTS INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:MARTIN
Authorized Official - Middle Name:B
Authorized Official - Last Name:POPP
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:513-421-4504
Mailing Address - Street 1:2123 AUBURN AVE STE 420
Mailing Address - Street 2:
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45219-2906
Mailing Address - Country:US
Mailing Address - Phone:513-421-4504
Mailing Address - Fax:513-421-4507
Practice Address - Street 1:2123 AUBURN AVE STE 420
Practice Address - Street 2:
Practice Address - City:CINCINNATI
Practice Address - State:OH
Practice Address - Zip Code:45219-2906
Practice Address - Country:US
Practice Address - Phone:513-421-4504
Practice Address - Fax:513-421-4507
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-07-25
Last Update Date:2007-07-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35-03-1878P2086X0206X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2086X0206XAllopathic & Osteopathic PhysiciansSurgerySurgical OncologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN100394580OtherEDS INDIANA MEDICAID