Provider Demographics
NPI:1356371561
Name:TRI STATE LUNG & SLEEP ASSOCIATES, INC
Entity type:Organization
Organization Name:TRI STATE LUNG & SLEEP ASSOCIATES, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:GHULAM
Authorized Official - Middle Name:R
Authorized Official - Last Name:AZIZ
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:330-382-9355
Mailing Address - Street 1:16218 SAINT CLAIR AVENUE
Mailing Address - Street 2:
Mailing Address - City:EAST LIVERPOOL
Mailing Address - State:OH
Mailing Address - Zip Code:43920-0076
Mailing Address - Country:US
Mailing Address - Phone:330-382-9355
Mailing Address - Fax:330-382-9448
Practice Address - Street 1:16218 SAINT CLAIR AVE
Practice Address - Street 2:
Practice Address - City:EAST LIVERPOOL
Practice Address - State:OH
Practice Address - Zip Code:43920-9449
Practice Address - Country:US
Practice Address - Phone:330-382-9355
Practice Address - Fax:330-382-9448
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-04
Last Update Date:2020-04-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHOH35-07-9747A207RS0012X
207RC0200X, 207RP1001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary DiseaseGroup - Multi-Specialty
No207RS0012XAllopathic & Osteopathic PhysiciansInternal MedicineSleep MedicineGroup - Multi-Specialty
No207RC0200XAllopathic & Osteopathic PhysiciansInternal MedicineCritical Care MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2254984Medicaid
90768OtherNATIONWIDE HEALTH PLANS
OH151908826002OtherMEDICAL MUTUAL OF OHI
5246690OtherAETNA
PA1408622OtherHIGHMARK BCBS
OH151908826-00OtherBWC
151908826OtherTRICARE
WV1807927000Medicaid
OH000000218659OtherANTHEM BCBS
110233707OtherRRMC
OH2254984Medicaid
OH9320711Medicare ID - Type UnspecifiedGROUP NUMBER
WA=========001OtherMOUNTAIN STATE BCBS
151908826OtherTRICARE