Provider Demographics
NPI:1649454034
Name:TRI STATE URGENT CARE LLC
Entity type:Organization
Organization Name:TRI STATE URGENT CARE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANANDER
Authorized Official - Prefix:MS
Authorized Official - First Name:THORAYA
Authorized Official - Middle Name:
Authorized Official - Last Name:HASSAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:513-531-1555
Mailing Address - Street 1:3699 ALEXANDRIA PK
Mailing Address - Street 2:COLD SPRING URGENT CARE
Mailing Address - City:COLD SPRING
Mailing Address - State:KY
Mailing Address - Zip Code:41076
Mailing Address - Country:US
Mailing Address - Phone:859-442-8444
Mailing Address - Fax:859-442-8777
Practice Address - Street 1:3699 ALEXANDRIA PK
Practice Address - Street 2:
Practice Address - City:COLD SPRING
Practice Address - State:KY
Practice Address - Zip Code:41076
Practice Address - Country:US
Practice Address - Phone:859-442-8444
Practice Address - Fax:859-442-8777
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-12-21
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
364SA2100X
KY261QE0002X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QE0002XAmbulatory Health Care FacilitiesClinic/CenterEmergency CareGroup - Single Specialty
No364SA2100XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse SpecialistAcute CareGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY65942864Medicaid
OH2572130Medicaid
KY9062Medicare PIN
KY65942864Medicaid