Tri State Medical LLC

Primary specialty

Family Medicine PhysicianTaxonomy code 207Q00000X

Legal business name

TRI STATE MEDICAL LLC

Practice address

5633 Tylersville Rd Ste B
Mason, OH 45040-2533

Phone

(937) 681-9258

NPI assigned

Mar 24, 2023

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Stephen Ericson

Title

Member

Phone

(937) 681-9258

Specialties & licenses 1

Addresses

Locations

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1679616000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1679616000000",
    "number": "1417650847",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5633 TYLERSVILLE RD STE B",
            "city": "MASON",
            "state": "OH",
            "postal_code": "450402533"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5633 TYLERSVILLE RD STE B",
            "city": "MASON",
            "state": "OH",
            "postal_code": "450402533",
            "telephone_number": "937-681-9258"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "TRI STATE MEDICAL LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2023-03-24",
        "last_updated": "2023-03-24",
        "certification_date": "2023-03-24",
        "status": "A",
        "authorized_official_last_name": "ERICSON",
        "authorized_official_first_name": "STEPHEN",
        "authorized_official_title_or_position": "MEMBER",
        "authorized_official_telephone_number": "937-681-9258"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Family Medicine",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Family Medicine Physician in Mason, OH
• Providers in Mason, OH by specialty
• Family Medicine Physician in Ohio

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 24, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.