Organization
TRI-STATE GASTROENTEROLOGY ASSOCIATES, PSC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. DANIEL G FAGEL M.D. (PRESIDENT)
(859) 341-3575
Entity
Organization
Contact information
Practice address
425 CENTRE VIEW BLVD, CRESTVIEW HILLS, KY 41017-3409
(859) 341-3575
(859) 341-5701
Mailing address
425 CENTRE VIEW BLVD, CRESTVIEW HILLS, KY 41017-3409
(859) 341-3575
(859) 341-5701
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
—
—
207RG0100X
Gastroenterology Physician
—
—
261Q00000X
Clinic/Center
Primary
—
—
363A00000X
Physician Assistant
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000000032466
ANTHEM
—
05
—
0835841
—
OH
05
—
200354220
—
IN
05
—
6591623100
—
KY
01
—
7100179230
KY MEDICAID PA GROUP
KY
01
—
78901550
KY MEDICAID NP GROUP
KY
01
—
CM0475
MEDICARE RAILROAD
—
Enumeration date
06/30/2005
Last updated
10/07/2014
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