| Tri State Neurology, Pllc | |
|
1450 Diederich Blvd Russell KY 41169-1719 | |
| (606) 836-5565 | |
| (606) 836-5567 |
| Full Name | Tri State Neurology, Pllc |
|---|---|
| Speciality | Psychiatry & Neurology - Neurology |
| Location | 1450 Diederich Blvd, Russell, Kentucky |
| Authorized Official Name and Position | Steven Douglas Deitch (OWNER) |
| Authorized Official Contact | 6068365565 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Tri State Neurology, Pllc 1450 Diederich Blvd Russell KY 41169-1719 Ph: (606) 836-5565 | Tri State Neurology, Pllc 1450 Diederich Blvd Russell KY 41169-1719 Ph: (606) 836-5565 |
| NPI Number | 1366849283 |
|---|---|
| Provider Enumeration Date | 11/20/2014 |
| Last Update Date | 11/21/2014 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1366849283 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 2084N0400X | Psychiatry & Neurology - Neurology | 26535 (Kentucky) | Primary |
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