Provider Demographics
NPI:1770594061
Name:TRI STATE NEPHROLOGY ASSOCIATES PSC
Entity type:Organization
Organization Name:TRI STATE NEPHROLOGY ASSOCIATES PSC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:DONALD
Authorized Official - Middle Name:N
Authorized Official - Last Name:HAMMONDS
Authorized Official - Suffix:JR
Authorized Official - Credentials:DO
Authorized Official - Phone:606-329-9335
Mailing Address - Street 1:432 16TH ST
Mailing Address - Street 2:P.O.BOX 2468
Mailing Address - City:ASHLAND
Mailing Address - State:KY
Mailing Address - Zip Code:41101-7693
Mailing Address - Country:US
Mailing Address - Phone:606-329-9335
Mailing Address - Fax:606-324-6383
Practice Address - Street 1:432 16TH ST STE B
Practice Address - Street 2:
Practice Address - City:ASHLAND
Practice Address - State:KY
Practice Address - Zip Code:41101-7693
Practice Address - Country:US
Practice Address - Phone:606-329-9335
Practice Address - Fax:606-324-6383
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-11
Last Update Date:2008-06-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY65918237Medicaid
OH0833263Medicaid
KY4893Medicare PIN
KY65918237Medicaid