TRI-STATE MEDICAL SPECIALISTS LLC (NPI# 1023302643) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1023302643 |
| Entity Type | Organization |
| Organization Name | TRI-STATE MEDICAL SPECIALISTS LLC |
| Other Organization Name | TRISTATE PAIN INSTITUTE |
| Practice Address |
1510 Wagon Wheel Lane Suite 110 Fort Mohave AZ 86426-6698 |
| Mailing Address |
2980 N Beverly Glen Cir Suite 100 Los Angeles CA 90077-1726 |
| Practice Telephone | 9287883333 |
| Mailing Telephone | 3104749809 |
| Mailing Fax Number | 8884318819 |
| Enumeration Date | 2011-05-31 |
| Last Update Date | 2016-03-02 |
| Authorized Official Name | BENJAMIN VENGER (OWNER) |
| Authorized Official Telephone | 9287883333 |
| Authorized Official Credential | MD |
| Is Organization Subpart | Y |
| Parent Organization Name | TRI-STATE MEDICAL SPECIALISTS LLC |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 332900000X | Non-Pharmacy Dispensing Site | Suppliers |
| Other Name | Type Code |
|---|---|
| Tristate Pain Institute | Doing Business As Name - Organization |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1811464118 | Tri-state Medical Specialists LLC | Neurological Surgery | 9555 South Eastern Avenue, Ste. 210, Henderson, NV 89121 | 2018-10-25 |
| 1649598426 | Tri-state Medical Specialists LLC | Anesthesiology | 1510 E Wagon Wheel Ln Ste 110, Fort Mohave, AZ 86426-6698 | 2010-05-04 |
| Street Address |
1510 WAGON WHEEL LANE SUITE 110 |
| City | FORT MOHAVE |
| State | AZ |
| Zip Code | 86426-6698 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1831740687 | Melissa Janos | Pharmacist | 4823 S, Az-95, Fort Mojave, AZ 86426 | 2019-09-24 |
| 1659774909 | Nicole Eileen Cash | Nurse Practitioner | 5653 S Highway 95 Ste A, Fort Mohave, AZ 86426 | 2014-10-01 |
| 1780009621 | Valley View Physician Practices, LLC | Physical Medicine & Rehabilitation | 5300 S. Highway 95, Ste. D., Ft. Mohave, AZ 86426 | 2014-03-02 |
| 1982840872 | Leticia Alcala | Massage Therapist | 5455 Hwy 95, Fort Mohave, AZ 86426 | 2008-12-23 |
| 1730387432 | Steven Dewayne Smart | Physical Therapist | 1988 Gemini St, Fort Mohave, AZ 86426 | 2007-07-05 |
| 1154543569 | Jonathan M. Brown, D.o., P.C. | Otolaryngology | 5300 South Highway 95, Suite M, Fort Mohave, AZ 86426 | 2007-05-03 |
| 1205931839 | Jennifer Lind Womack | Dietitian, Registered | 5300 S. Highway 95 Ste A, Fort Mohave, AZ 86426 | 2006-09-14 |
| 1053421057 | Kaye A Cunningham Md PC | Family Medicine | 5653 Hwy 95, Suite A, Fort Mohave, AZ 86426 | 2006-08-30 |
| 1780790576 | American Medical Imaging Inc | Radiology | 1517 E Aztec Ln, Fort Mohave, AZ 86426 | 2006-08-22 |
| 1902833817 | Allen E Stout | Chiropractor | 5130 Hwy 95, Fort Mohave, AZ 86426 | 2006-06-27 |
| Find all providers in zip 86426 | ||||
| Taxonomy Code | 332900000X |
| Grouping | Suppliers |
| Classification | Non-Pharmacy Dispensing Site |
| A site other than a pharmacy that dispenses medicinal preparations under the supervision of a physician to patients for self-administration. (e.g. physician offices, ER, Urgent Care Centers, Rural Health Facilities, etc.) |
| Notes: Source: Developed by National Council for Prescription Drug Programs (NCPDP), National Home Infusion Association (NHIA), and Pharmacist Services Technical Advisory Coalition (PSTAC) [1/1/2006: new] |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1609375740 | Cerner Health Connections, Inc | Non-Pharmacy Dispensing Site | 89 Civic Center Ln, Lake Havasu City, AZ 86403-0810 | 2018-02-05 |
| 1518318328 | John C Lincoln, LLC | Non-Pharmacy Dispensing Site | 6220 W Bell Rd, Suite 100, Glendale, AZ 85308-3718 | 2016-06-23 |
| 1992178982 | Caremore Health Plan of Arizona Inc | Non-Pharmacy Dispensing Site | 315 W Irvington Rd, Ste.101, Tucson, AZ 85714-3151 | 2015-11-12 |
| 1558747725 | Arizona Oncology Associates, PC | Non-Pharmacy Dispensing Site | 3188 N Windsong Dr # Sr, Ste. # A, Prescott Valley, AZ 86314-1220 | 2015-08-10 |
| 1578976379 | Arizona Oncology Associates PC | Non-Pharmacy Dispensing Site | 1315 S La Canada Dr, Green Valley, AZ 85622-1915 | 2014-06-09 |
| 1396066395 | Wound Care Usa, LLC | Non-Pharmacy Dispensing Site | 3959 E Speedway Blvd, Suite 316, Tucson, AZ 85712-4553 | 2010-06-14 |
| 1417112541 | Gold Canyon Internal Medicine | Non-Pharmacy Dispensing Site | 6724 S Kings Ranch Rd Ste 102, Gold Canyon, AZ 85118-2963 | 2008-07-29 |
| 1740442573 | Cardiovascular Consultants, Ltd | Non-Pharmacy Dispensing Site | 10210 N. 92nd St, Suite 301, Scottsdale, AZ 85258 | 2008-07-02 |
| 1558523381 | Cardiovascular Consultants, Ltd | Non-Pharmacy Dispensing Site | 18700 N. 64th Dr, Suite 101, Glendale, AZ 85308 | 2008-07-02 |
| 1609038439 | Cardiovascular Consultants, Ltd | Non-Pharmacy Dispensing Site | 6036 N. 19th Ave, Suite 312, Phoenix, AZ 85015 | 2008-07-02 |
| Find all providers with the same taxonomy | ||||
| City | FORT MOHAVE |
| Zip Code | 86426 |
Please comment or provide details below to improve the information on TRI-STATE MEDICAL SPECIALISTS LLC.
| 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.