# TRI-STATE UROLOGY

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1356494876
- **Authorized official:** MARK JOSEPH SWOFFORD D.O. (PRESIDENT PHYSICIAN)
- **Authorized official phone:** (606) 437-9550

## Contact information

- **Practice address:** 255 CHURCH ST, STE. 202, PIKEVILLE, KY 41501-3476
- **Practice address phone:** (606) 437-9550
- **Practice address fax:** (606) 437-9510
- **Mailing address:** PO BOX 2438, PIKEVILLE, KY 41502-2438
- **Mailing address phone:** (606) 437-9550
- **Mailing address fax:** (606) 437-9510

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 208800000X | Urology Physician | 02625 | KY | Yes |

## Other

- **Enumeration date:** 01/19/2007
- **Last updated:** 09/21/2010

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 05 | — | 1245238484 | — | KY |
| 05 | — | 65935009 | — | KY |