Tri-State Podiatric Medical Services PSC

Primary specialty

PodiatristTaxonomy code 213E00000X

Legal business name

TRI-STATE PODIATRIC MEDICAL SERVICES PSC

Practice address

411 Letcher St
Henderson, KY 42420-4245

Phone

(270) 830-6522

NPI assigned

Mar 22, 2007

Organization subpart

No

Name

Edward G Anderson, D.P.M.NPI 1366445462

Title

Podiatrist Owner

Phone

(270) 830-5522

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Edward Anderson, DPM

  • Podiatrist
  • Henderson, KY
  • NPI 1366445462

  KY

  Medicare reassignment Authorized official
• Nicasio Villarreal Jr., KCSA

  • Surgical Assistant
  • Bowling Green, KY
  • NPI 1225188949
  NPD (past)

Medicare fee-for-service enrollment

Enrolled in KY

Enrollment records 1

The complete NPPES record for this NPI in the NPI Registry API format, last updated by the provider on Oct 25, 2016.

{
    "created_epoch": "1174521600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1477353600000",
    "number": "1750407474",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 1593",
            "city": "HENDERSON",
            "state": "KY",
            "postal_code": "424191593",
            "telephone_number": "270-830-6522"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "411 LETCHER ST",
            "city": "HENDERSON",
            "state": "KY",
            "postal_code": "424204245",
            "telephone_number": "270-830-6522"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "TRI-STATE PODIATRIC MEDICAL SERVICES PSC",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-03-22",
        "last_updated": "2016-10-25",
        "status": "A",
        "authorized_official_last_name": "ANDERSON",
        "authorized_official_first_name": "EDWARD",
        "authorized_official_middle_name": "G",
        "authorized_official_title_or_position": "PODIATRIST OWNER",
        "authorized_official_telephone_number": "270-830-5522",
        "authorized_official_credential": "D.P.M."
    },
    "taxonomies": [
        {
            "code": "213E00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Podiatrist",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "RAILROAD MEDICARE",
            "identifier": "CK6362",
            "state": "KY"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Ashley Traylor, CPHT
• Makaylah B Trent, NP
• Tri-State Comprehensive Care PLLC
• Tri-State Occupational Therapy
• Tri-State Orthopaedic Surgeons, Inc
• Alan Matthew Tripp, D.O.
• Katherine Tsironis
• McKenzie B Tucker, DO
• Ralph Steven Tweddell, LPCC
• Tyler J. Unfried, PA

• All providers in Henderson, KY
• Podiatrist in Kentucky

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 25, 2016; 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.