NPIMap

Organization Active NPI

Tri-State Health, Inc.

Doing business as Tristate Diagnostic Labs

  • Clinical Medical Laboratory
  • Elkton, MD
National Provider Identifier
1609348325
Registry record updated Feb 5, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinical Medical LaboratoryTaxonomy code 291U00000X
Legal business name
TRI-STATE HEALTH, INC.
Doing business as
Tristate Diagnostic Labs
Practice address
107 N Bridge St
Elkton, MD 21921-5326
Phone
(410) 392-6408
Fax
(410) 392-6409
NPI assigned
Dec 19, 2018
Last updated
Feb 5, 2024By the provider in NPPES
Organization subpart
Yes
Parent organization
TR-STATE HEALTH INCAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Feb 5, 2024

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

Authorized official

Name
Muhammed Arif NiazNPI 1255338869
Title
MD
Phone
(410) 392-6408

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Clinical Medical Laboratory 291U00000X NU Primary

Addresses

Primary practice location

107 N Bridge St
Elkton, MD 21921-5326

Mailing address

107 N Bridge St
Elkton, MD 21921-5326
Phone (410) 392-6408

Other practice location 1

107 N Bridge St
Elkton, MD 21921-5326
Phone (410) 392-6408

Other identifiers 1

IdentifierTypeStateIssuer
558904500MedicaidMD

Other names 1

  • Tristate Diagnostic Labs Doing business as

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MD

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20200406001534 MD Part B Supplier - Independent Clinical Laboratory 0143328153 Practice locations: Elkton, MD

Other NPIs with the same Medicare PAC ID 1

NPIs whose Medicare enrollments share a PECOS associate control ID (the same enrolled entity).

National Provider Directory

National Provider Directory
Tax ID family
Tri State Health Inc5 organizations share this tax ID, including this one
Part of
Tri State Health Inc

Other organizations with this tax ID 4

Organizations that report the same tax identification number in the National Provider Directory.

Practitioners & affiliated clinicians

Practitioners 5

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

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

{
    "created_epoch": "1545177600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1707091200000",
    "number": "1609348325",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "107 N BRIDGE ST",
            "city": "ELKTON",
            "state": "MD",
            "postal_code": "219215326",
            "telephone_number": "410-392-6408",
            "fax_number": "410-392-6409"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "107 N BRIDGE ST",
            "city": "ELKTON",
            "state": "MD",
            "postal_code": "219215326",
            "telephone_number": "410-392-6408",
            "fax_number": "410-392-6409"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "107 N Bridge St",
            "address_purpose": "LOCATION",
            "city": "Elkton",
            "state": "MD",
            "postal_code": "219215326",
            "country_code": "US",
            "telephone_number": "410-392-6408",
            "fax_number": "410-392-6409",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "organization_name": "TRI-STATE HEALTH, INC.",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "TR-STATE HEALTH INC",
        "enumeration_date": "2018-12-19",
        "last_updated": "2024-02-05",
        "certification_date": "2024-02-05",
        "status": "A",
        "authorized_official_last_name": "NIAZ",
        "authorized_official_first_name": "MUHAMMED",
        "authorized_official_middle_name": "ARIF",
        "authorized_official_title_or_position": "MD",
        "authorized_official_telephone_number": "410-392-6408"
    },
    "taxonomies": [
        {
            "code": "291U00000X",
            "taxonomy_group": "",
            "desc": "Clinical Medical Laboratory",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "558904500",
            "state": "MD"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Tristate Diagnostic Labs",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Elkton, MD

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 5, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.