Jack Diep (NPI# 1912333014, PAC ID# 6800142753) is a physician enrolled in Centers for Medicare & Medicaid Services (CMS). The primary specialty is PAIN MANAGEMENT.
| Nation Provider ID (NPI) | 1912333014 |
| PAC ID by PECOS | 6800142753 |
| Professional Enrollment ID | I20180706000866 |
| Full Name | Jack Diep |
| Organization Legal Name | TRI-STATE MEDICAL SPECIALISTS LLC |
| Address |
1510 E Wagon Wheel Ln Suite 110 Ft Mohave AZ 86426-6697 |
| Phone Number | 9287883333 |
| Gender | M |
| Graduation Year | 2013 |
| Primary Specialty | PAIN MANAGEMENT |
| Secondary Specialties | ANESTHESIOLOGY, INTERVENTIONAL PAIN MANAGEMENT |
| Group Practice PAC ID | 1850422023 |
| Number of Group Practice Members | 6 |
| Accepts Medicare Assignment | Y |
| Claim Control Number (CCN) | Legal Business Name |
|---|---|
| 030069 | HAVASU REGIONAL MEDICAL CENTER |
| Address | Phone | Organization |
|---|---|---|
| 1510 E Wagon Wheel Ln, Suite 110, Ft Mohave, AZ 86426-6697 | 9287883333 | TRI-STATE MEDICAL SPECIALISTS LLC |
| 7135 W Sahara Ave, Suite 101, Las Vegas, NV 89117-2828 | 7022275848 | TRI-STATE MEDICAL SPECIALISTS LLC |
| Organization Legal Name | TRI-STATE MEDICAL SPECIALISTS LLC |
| Physicians | 7 |
| Name | Specialty | Organization | Address |
|---|---|---|---|
| Catherine R Nevels | Nurse Practitioner | Tri-state Medical Specialists LLC | 1510 E Wagon Wheel Ln, Suite 110, Ft Mohave, AZ 86426-6697 |
| Benjamin H Venger | Pain Management | Tri-state Medical Specialists LLC | 1987 Mcculloch Blvd N, Suite 101, Lake Havasu City, AZ 86403-5770 |
| Jaspreet Singh | Pain Management | Tri-state Medical Specialists LLC | 1510 E Wagon Wheel Ln, Suite 110, Ft Mohave, AZ 86426-6697 |
| Okey Iloegbunam | Nurse Practitioner | Tri-state Medical Specialists LLC | 1510 E Wagon Wheel Ln, Suite 110, Ft Mohave, AZ 86426-6697 |
| Mary D Janikowski | Internal Medicine | Tri-state Medical Specialists LLC | 1987 Mcculloch Blvd N, Suite 101, Lake Havasu City, AZ 86403-5770 |
| Han-chin C Huang | Nurse Practitioner | Tri-state Medical Specialists LLC | 1987 Mcculloch Blvd N, Lake Havasu City, AZ 86403-5770 |
| Street Address |
1510 E WAGON WHEEL LN SUITE 110 |
| City | FT MOHAVE |
| State | AZ |
| Zip | 86426-6697 |
| Name | Specialty | Organization | Address |
|---|---|---|---|
| Catherine R Nevels | Nurse Practitioner | Tri-state Medical Specialists LLC | 1510 E Wagon Wheel Ln, Suite 110, Ft Mohave, AZ 86426-6697 |
| Jaspreet Singh | Pain Management | Tri-state Medical Specialists LLC | 1510 E Wagon Wheel Ln, Suite 110, Ft Mohave, AZ 86426-6697 |
| Okey Iloegbunam | Nurse Practitioner | Tri-state Medical Specialists LLC | 1510 E Wagon Wheel Ln, Suite 110, Ft Mohave, AZ 86426-6697 |
| Name | Specialty | Organization | Address |
|---|---|---|---|
| Cesar K Katigbak | Family Medicine | Bullhead City Clinic Corp | 5653 S Hwy 95, Suite A, Fort Mohave, AZ 86426-6069 |
| David M Freedman | Family Medicine | Vista Health Mirza Md PC | 5653 Hwy 95, Suite A, Fort Mohave, AZ 86426-6069 |
| Ronald S Bennett | Neurology | Vista Health Mirza Md PC | 5653 Hwy 95, Suite A, Fort Mohave, AZ 86426-6069 |
| Sheila Marie Sanders | Chiropractic | Polly's Chiropractic, P.C. | 5810 S Hwy 95 2, Fort Mohave, AZ 86426-6076 |
| Polly A Hediger | Chiropractic | Polly's Chiropractic, P.C. | 5810 S Hwy 95 2, Fort Mohave, AZ 86426-6076 |
| Muhammad A Nayer | Neurology | 1520 E Hammer Ln, Suite 103, Fort Mohave, AZ 86426-6665 | |
| Pamela B Reband | Anesthesiology | Capstone Medical Arizona LLC | 4825 S Hwy 95 2-356, Fort Mohave, AZ 86426-8315 |
| Michele M Holley | Anesthesiology | Capstone Medical Arizona LLC | 4825 S Hwy 95 2-356, Fort Mohave, AZ 86426-8315 |
| Dayna L Blake | Nurse Practitioner | Mohave Family Healthcare | 1611 Joy Lane, Fort Mohave, AZ 86426-8807 |
| Lisa J Carpenter | Physician Assistant | Mohave Family Healthcare | 1611 Joy Lane, Fort Mohave, AZ 86426-8807 |
| Find all physicians in zip 86426 | |||
| City | FT MOHAVE |
| Zip Code | 86426 |
| Specialty | PAIN MANAGEMENT |
| City + Specialty | FT MOHAVE + PAIN MANAGEMENT |
Please comment or provide details below to improve the information on Jack Diep.
| Data Provider | Centers for Medicare & Medicaid Services (CMS) |
| Jurisdiction | Medicare |
This dataset includes 1.12 million groups, individual physicians, and other clinicians currently enrolled in Medicare. Each physician is registered with NPI, PAC ID, full name, specialty, phone, organization, hospital, address, medical school, etc.