Organization
TRI-STATE GASTROENTEROLOGY ASSOCIATES, PSC
Active
Other names
Tri-State Digestive Disorder Center
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) 341-5702
Mailing address
425 CENTRE VIEW BLVD, CRESTVIEW HILLS, KY 41017-3409
(859) 341-3575
(859) 341-5702
Taxonomy
Speciality
Code
Description
License number
State
261QA1903X
Ambulatory Surgical Clinic/Center
Primary
300096
KY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000000003071
ANTHEM
—
05
—
200354210A
—
IN
01
—
490002071
MEDICARE RAILROAD
—
05
—
7100169710
—
KY
Enumeration date
06/30/2005
Last updated
01/13/2015
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