Provider Demographics
NPI:1912973553
Name:TRI-STATE LYMPHEDEMA CLINIC
Entity Type:Organization
Organization Name:TRI-STATE LYMPHEDEMA CLINIC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:DEBORAH
Authorized Official - Middle Name:A
Authorized Official - Last Name:RAUH
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:513-793-7710
Mailing Address - Street 1:10724 READING RD
Mailing Address - Street 2:
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45241-2529
Mailing Address - Country:US
Mailing Address - Phone:513-721-3504
Mailing Address - Fax:513-793-1748
Practice Address - Street 1:10724 READING RD
Practice Address - Street 2:
Practice Address - City:CINCINNATI
Practice Address - State:OH
Practice Address - Zip Code:45241-2529
Practice Address - Country:US
Practice Address - Phone:513-721-3504
Practice Address - Fax:513-793-1748
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-02-24
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes163W00000XNursing Service ProvidersRegistered NurseGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH00000016815OtherBC/BS