Tri State Neurology, PLLC
Organization Active NPI Neurology Physician · Russell, KY
NPI 1366849283 · NPPES record last updated Nov 21, 2014
Key facts
- NPI
- 1366849283
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Neurology Physician 2084N0400X
- License
- 26535 (KY)
- Legal business name
- TRI STATE NEUROLOGY, PLLC
- Practice address
- 1450 Diederich Blvd
Russell, KY 41169-1719 - Phone
- (606) 836-5565
- Fax
- (606) 836-5567
- NPI assigned
- Nov 20, 2014
- Organization subpart
- No
Authorized official
- Name
- Dr. Steven Douglas Deitch, M.D.
- Title
- Owner
- Phone
- (606) 836-5565
Practitioners 2
-
James Scott Powell, M.D.
-
Jerrel H Boyer, DO
National Provider Directory
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Neurology Physician |
2084N0400X | 26535 | KY | Yes |
Addresses
Primary practice location
1450 Diederich Blvd
Russell, KY 41169-1719
Mailing address
1450 Diederich Blvd
Russell, KY 41169-1719
Phone (606) 836-5565
Other providers in Russell, KY
- Jeremy Stephenson
- Supportive Med
- Deanna Binion Tatterson
- The Nest Day Spa LLC
- Lourente Bacus Tigas
- Tri-State Healing Initiative LLC
- Melissa Westfall
All providers in Russell, KY · Neurology Physician in Kentucky
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Nov 21, 2014. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.