Organization Name:  TRI-STATE GASTROENTEROLOGY ASSOCIATES, PSC


Practice Location:
425 CENTRE VIEW BLVD  CRESTVIEW HILLS, KY 41017 US
Tel: 859-341-3575  Fax: --

Business Mailing Address:
  ,   
Tel: --  Fax: --


Taxonomy:

Primary	Code	Category/Description	State	License Number
Y	261QA1903X	Ambulatory Health Care Facilities Clinic/Center Ambulatory Surgical	KY	300096

Other Provider Identifiers:

Issuer	Number	State	Type
	7100169710	KY	05
ANTHEM	000000003071		01
	200354210A	IN	05
MEDICARE RAILROAD	490002071		01

Code values:
01, Other | 02, Medicare Upin | 04, Medicare Id-Type Unspecified
05, Medicaid | 06, Medicare Oscar/Certification | 07, Medicare NSC | 08, Medicare Pin