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Organization
TRI-STATE MEDICAL GROUP LLC
Active
Organization
TRI-STATE MEDICAL GROUP LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
PETER MORDUKHAYEV (AUTHORIZED OFFICAL)
(800) 607-4491
Entity
Organization
Contact information
Practice address
2621 N FEDERAL HWY STE S, BOCA RATON, FL 33431-7785
(800) 607-4491
(561) 757-5850
Mailing address
2621 N FEDERAL HWY STE S, BOCA RATON, FL 33431-7785
(800) 607-4491
(561) 757-5850
Taxonomy
Speciality
Code
Description
License number
State
332B00000X
Durable Medical Equipment & Medical Supplies
Primary
—
NULL
Other
Enumeration date
10/26/2020
Last updated
10/26/2020
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