Basic Information
| Provider Information | |||||||||
| NPI: | 1346219839 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | TRI-STATE ANESTHESIOLOGY, PSC | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 2558 | ||||||||
| Address2: | |||||||||
| City: | ASHLAND | ||||||||
| State: | KY | ||||||||
| PostalCode: | 411052558 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7702371089 | ||||||||
| FaxNumber: | 7702371124 | ||||||||
| Practice Location | |||||||||
| Address1: | 2201 LEXINGTON AVE | ||||||||
| Address2: | ANESTHESIA DEPT | ||||||||
| City: | ASHLAND | ||||||||
| State: | KY | ||||||||
| PostalCode: | 411012843 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6063274000 | ||||||||
| FaxNumber: | 7702371124 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 03/16/2006 | ||||||||
| LastUpdateDate: | 07/21/2022 | ||||||||
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| AuthorizedOfficialLastName: | IYER | ||||||||
| AuthorizedOfficialFirstName: | SRIRAM | ||||||||
| AuthorizedOfficialMiddleName: | K | ||||||||
| AuthorizedOfficialTitleorPosition: | PRESIDENT | ||||||||
| AuthorizedOfficialTelephone: | 6063274000 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialCredential: | MD | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207L00000X | KY | Y | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Anesthesiology |
No ID Information.