Organization
TRI-STATE PAIN MANAGEMENT SERVICE INC
Active
Organization
TRI-STATE PAIN MANAGEMENT SERVICE INC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
JEWELL ASHLEY (OFFICE MANAGER)
(513) 624-7525
Entity
Organization
Contact information
Practice address
4415 AICHOLTZ RD, CINCINNATI, OH 45245-1506
(859) 341-7246
(859) 341-7867
Mailing address
7655 5 MILE RD STE 117, CINCINNATI, OH 45230-4326
(513) 624-7525
(513) 624-0578
Taxonomy
Speciality
Code
Description
License number
State
208VP0014X
Interventional Pain Medicine Physician
Primary
—
—
363L00000X
Nurse Practitioner
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
200529320A
—
IN
05
—
2044773
—
OH
01
—
284941995017
MEDICAL MUTUAL
—
01
—
5124498
CIGNA
—
01
—
610168000
FEDERAL WORKERS COMP
—
05
—
65944233
—
KY
01
—
728014
BUCKEYE
—
Enumeration date
04/01/2008
Last updated
03/24/2020
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