Provider Demographics
NPI:1447726807
Name:TRI-STATE CLINICAL RESEARCH TRIALS, LLC
Entity type:Organization
Organization Name:TRI-STATE CLINICAL RESEARCH TRIALS, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEDICAL DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:BERNARD
Authorized Official - Middle Name:
Authorized Official - Last Name:OGON
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:773-983-2866
Mailing Address - Street 1:1303 VETERANS HWY
Mailing Address - Street 2:
Mailing Address - City:BRISTOL
Mailing Address - State:PA
Mailing Address - Zip Code:19007-2514
Mailing Address - Country:US
Mailing Address - Phone:215-458-7114
Mailing Address - Fax:215-458-7994
Practice Address - Street 1:1303 VETERANS HWY
Practice Address - Street 2:
Practice Address - City:BRISTOL
Practice Address - State:PA
Practice Address - Zip Code:19007-2514
Practice Address - Country:US
Practice Address - Phone:215-458-7114
Practice Address - Fax:215-458-7994
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-10-23
Last Update Date:2018-10-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR1100XAmbulatory Health Care FacilitiesClinic/CenterResearch
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA1028959680001Medicaid