TRI STATE NEUROLOGY, PLLC (NPI# 1366849283) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1366849283 |
| Entity Type | Organization |
| Organization Name | TRI STATE NEUROLOGY, PLLC |
| Practice Address |
1450 Diederich Blvd Russell KY 41169-1719 |
| Practice Telephone | 6068365565 |
| Practice Fax Number | 6068365567 |
| Mailing Telephone | 6068365565 |
| Mailing Fax Number | 6068365567 |
| Enumeration Date | 2014-11-20 |
| Last Update Date | 2014-11-21 |
| Authorized Official Name | DR. STEVEN DOUGLAS DEITCH (OWNER) |
| Authorized Official Telephone | 6068365565 |
| Authorized Official Credential | M.D. |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 2084N0400X |
Psychiatry & Neurology Specialization: Neurology |
26535 | KY | Allopathic & Osteopathic Physicians |
| Street Address |
1450 DIEDERICH BLVD |
| City | RUSSELL |
| State | KY |
| Zip Code | 41169-1719 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1497778633 | James Scott Powell | Neurological Surgery | 1450 Diederich Blvd, Russell, KY 41169-1719 | 2006-07-26 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1346552999 | Joseph Ray Bowling | Optometrist | 112 S Vinson Blvd, Louisa, KY 41169 | 2010-07-12 |
| 1508031980 | Alissa R Parker | Nurse Practitioner | 105 Thompson Road, Russell, KY 41169 | 2008-04-25 |
| 1770703829 | Elmer H Mullins Jr. | Dentist | 1452 Diederich Blvd, Russell, KY 41169 | 2007-04-30 |
| 1790862233 | Premier Therapy & Health Centers, Inc. | Clinic/Center | 1490 Diederich Blvd, Russell, KY 41169 | 2006-11-01 |
| 1710073580 | Angela Dawn Lewis | Family Medicine | 1021 Kenwood Dr, Russell, KY 41169 | 2006-10-05 |
| 1972600609 | Tiffany Blanton | Counselor | 1448 Diederich Boulveard, Russell, KY 41169 | 2006-09-17 |
| 1821008335 | Lena A Harmon | Psychologist | 1448 Diederich Blvd, Russell, KY 41169 | 2006-08-08 |
| 1831645779 | Courtney Joyce | Counselor | 1448 Diederich Blvd, Russell, KY 41169 | 2016-08-31 |
| 1245436757 | Debora K Reeves | Counselor | 1448 Diederich Blvd, Russell, KY 41169 | 2007-06-22 |
| 1164044533 | Melissa Westfall | Registered Nurse | 440 Greenup Rd, Russell, KY 41169-1087 | 2020-05-08 |
| Find all providers in zip 41169 | ||||
| Taxonomy Code | 2084N0400X |
| Grouping | Allopathic & Osteopathic Physicians |
| Classification | Psychiatry & Neurology |
| Specialization | Neurology |
| A Neurologist specializes in the diagnosis and treatment of diseases or impaired function of the brain, spinal cord, peripheral nerves, muscles, autonomic nervous system, and blood vessels that relate to these structures. |
| Notes: Source: The American Board of Psychiatry and Neurology, Inc. www.abpn.com [1/1/2007: new definition] |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1215469366 | Paige Elise Sutton | Psychiatry & Neurology | 740 S Limestone Rm L-445, Lexington, KY 40536 | 2017-03-29 |
| 1356872238 | Fred Ochieng Odago | Psychiatry & Neurology | 3518 Willowood Rd, Lexington, KY 40517-2760 | 2017-03-23 |
| 1558811323 | Kentucky Medical Center, Psc | Psychiatry & Neurology | 208 Legends Ln, Suite 130, Lexington, KY 40505-3285 | 2016-10-05 |
| 1114372141 | Marwa Ali Mahgoub Elnazeir | Psychiatry & Neurology | 401 E Chestnut St Ste 500, Louisville, KY 40202-5700 | 2016-04-27 |
| 1427411537 | James Lamb | Psychiatry & Neurology | 500 S Preston St Dept Of, Hsc #113, Louisville, KY 40202-1702 | 2016-04-05 |
| 1194111807 | Murali Kolikonda | Psychiatry & Neurology | 500 S. Preston St., Rm. 113, Louisville, KY 40202 | 2015-04-09 |
| 1366852311 | Ruta Nandan Yardi | Psychiatry & Neurology | 740 S Limestone Ste B101, Lexington, KY 40536-0284 | 2014-04-30 |
| 1639511041 | Sushanth Rao Aroor | Psychiatry & Neurology | 740 S Limestone L445, Lexington, KY 40508-0284 | 2013-07-26 |
| 1629412150 | Lei Zhou | Psychiatry & Neurology | 740 S Limestone Room L-445, Lexington, KY 40536-1200 | 2013-04-26 |
| 1629344882 | Patricia A Kleinholz-owens | Psychiatry & Neurology | 1800 Nicholasville Rd Ste 301, Lexington, KY 40503-1443 | 2012-03-31 |
| Find all providers with the same taxonomy | ||||
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.