Organization
TRI-STATE PODIATRIC MEDICAL SERVICES PSC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
EDWARD G ANDERSON D.P.M. (PODIATRIST OWNER)
(270) 830-5522
Entity
Organization
Contact information
Practice address
411 LETCHER ST, HENDERSON, KY 42420-4245
(270) 830-6522
Mailing address
PO BOX 1593, HENDERSON, KY 42419-1593
(270) 830-6522
Taxonomy
Speciality
Code
Description
License number
State
213E00000X
Podiatrist
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
CK6362
RAILROAD MEDICARE
KY
Enumeration date
03/22/2007
Last updated
10/25/2016
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