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
—
—
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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