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Organization
TRI STATE UROLOGIC SERVICES PSC INC
Active
Organization
TRI STATE UROLOGIC SERVICES PSC INC
Active
Other names
THE UROLOGY GROUP
Organization subpart
No
Provider details
NPI number
Authorized official
EARL L WALZ (CEO)
(513) 841-7400
Entity
Organization
Contact information
Practice address
605 WILSON CREEK RD, SUITE 01, LAWRENCEBURG, IN 47025-2506
(859) 363-2200
(859) 363-2201
Mailing address
2000 JOSEPH E SANKER BLVD, CINCINNATI, OH 45212-1979
(513) 841-7400
(513) 841-7402
Taxonomy
Speciality
Code
Description
License number
State
208800000X
Urology Physician
Primary
—
NULL
208800000X
Urology Physician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
200091770A
—
IN
01
—
DN9528
RAIROAD MEDICARE
IN
Enumeration date
08/22/2007
Last updated
01/11/2017
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