# TRI STATE UROLOGIC SERVICES PSC INC

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- **Entity:** Organization
- **Status:** Active
- **Other names:** THE UROLOGY GROUP
- **Organization subpart:** No

## Provider details

- **NPI number:** 1083807093
- **Authorized official:** EARL L WALZ (CEO)
- **Authorized official phone:** (513) 841-7400

## Contact information

- **Practice address:** 605 WILSON CREEK RD, SUITE 01, LAWRENCEBURG, IN 47025-2506
- **Practice address phone:** (859) 363-2200
- **Practice address fax:** (859) 363-2201
- **Mailing address:** 2000 JOSEPH E SANKER BLVD, CINCINNATI, OH 45212-1979
- **Mailing address phone:** (513) 841-7400
- **Mailing address fax:** (513) 841-7402

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 208800000X | Urology Physician | — | NULL | Yes |
| 208800000X | Urology Physician | — | — | Yes |

## Other

- **Enumeration date:** 08/22/2007
- **Last updated:** 01/11/2017

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 05 | — | 200091770A | — | IN |
| 01 | — | DN9528 | RAIROAD MEDICARE | IN |