Tri-State Behavioral Health LLC

Key facts

NPI: 1902073554
Entity type: Organization (NPI type 2)
Primary specialty: Psychiatry Physician 2084P0800X
License: 01048619A (IN)
Legal business name: TRI-STATE BEHAVIORAL HEALTH LLC
Practice address: 1116 Millis Ave
St. Mary'S Warrick
Boonville, IN 47601
Phone: (812) 962-2353
Fax: (812) 962-0915
NPI assigned: May 13, 2008
Organization subpart: No

Authorized official

Name: Dr. Anjum Shehzad Ashraf, M.D
Title: Member
Phone: (812) 962-2353

National Provider Directory

Specialties & licenses

Specialty (taxonomy)	Code	License	State	Primary
Psychiatry Physician Group: 193400000X SINGLE SPECIALTY GROUP	2084P0800X	01048619A	IN	Yes

Addresses

Primary practice location

1116 Millis Ave
St. Mary'S Warrick
Boonville, IN 47601

Mailing address

1900 Waters Ridge Dr
Newburgh, IN 47630-8084
Phone (812) 962-2353

Other identifiers

Identifier	Type	State	Issuer
200478750 A	Medicaid	IN
234630	Other	IN	MEDICARE - ID

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API JSON format, last updated by the provider on Apr 11, 2013.

{
    "created_epoch": "1210636800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1365638400000",
    "number": "1902073554",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1900 WATERS RIDGE DR",
            "city": "NEWBURGH",
            "state": "IN",
            "postal_code": "476308084",
            "telephone_number": "812-962-2353",
            "fax_number": "812-962-0915"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1116 MILLIS AVE",
            "address_2": "ST. MARY'S WARRICK",
            "city": "BOONVILLE",
            "state": "IN",
            "postal_code": "47601",
            "telephone_number": "812-962-2353",
            "fax_number": "812-962-0915"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "TRI-STATE BEHAVIORAL HEALTH LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2008-05-13",
        "last_updated": "2013-04-11",
        "status": "A",
        "authorized_official_last_name": "ASHRAF",
        "authorized_official_first_name": "ANJUM",
        "authorized_official_middle_name": "SHEHZAD",
        "authorized_official_title_or_position": "MEMBER",
        "authorized_official_telephone_number": "812-962-2353",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "M.D"
    },
    "taxonomies": [
        {
            "code": "2084P0800X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Psychiatry & Neurology, Psychiatry",
            "state": "IN",
            "license": "01048619A",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "200478750 A",
            "state": "IN"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICARE - ID",
            "identifier": "234630",
            "state": "IN"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Boonville, IN

All providers in Boonville, IN · Psychiatry Physician in Indiana

Sources for this page

NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Apr 11, 2013. 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.

Verify at the official NPI Registry.