Provider Demographics
NPI:1750697629
Name:TRI STATE TRAVEL HEALTH LLC
Entity type:Organization
Organization Name:TRI STATE TRAVEL HEALTH LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:MEDICAL DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:ALETHA
Authorized Official - Middle Name:W
Authorized Official - Last Name:TIPPETT
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:513-891-3093
Mailing Address - Street 1:10274 ALLIANCE RD
Mailing Address - Street 2:
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45242-4710
Mailing Address - Country:US
Mailing Address - Phone:513-891-3093
Mailing Address - Fax:513-891-9947
Practice Address - Street 1:10274 ALLIANCE RD
Practice Address - Street 2:
Practice Address - City:CINCINNATI
Practice Address - State:OH
Practice Address - Zip Code:45242-4710
Practice Address - Country:US
Practice Address - Phone:513-891-3093
Practice Address - Fax:513-891-9947
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-08-29
Last Update Date:2020-07-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHOH35074933261QM2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM2500XAmbulatory Health Care FacilitiesClinic/CenterMedical Specialty