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Organization
TRI-STATE MEDICAL SPECIALISTS LLC
Active
Organization
TRI-STATE MEDICAL SPECIALISTS LLC
Active
Other names
TriState Pain Institute
Organization subpart
No
Provider details
NPI number
Authorized official
KNAYA TABORA (OWNER/MEMBER MANAGER)
(928) 788-3333
Entity
Organization
Contact information
Practice address
1510 E WAGON WHEEL LN STE 110, FORT MOHAVE, AZ 86426-6698
(928) 788-3333
(928) 788-3555
Mailing address
1510 E WAGON WHEEL LN STE 110, FORT MOHAVE, AZ 86426-6698
(928) 788-3333
(928) 788-3555
Taxonomy
Speciality
Code
Description
License number
State
207LP2900X
Pain Medicine (Anesthesiology) Physician
—
NULL
207LP2900X
Pain Medicine (Anesthesiology) Physician
—
—
207T00000X
Neurological Surgery Physician
20605
AZ
207T00000X
Neurological Surgery Physician
5573
NY
2081P2900X
Pain Medicine (Physical Medicine & Rehabilitation) Physician
—
NULL
2081P2900X
Pain Medicine (Physical Medicine & Rehabilitation) Physician
—
—
208VP0000X
Pain Medicine Physician
20605
AZ
208VP0000X
Pain Medicine Physician
5573
NV
208VP0000X
Pain Medicine Physician
Primary
—
NULL
208VP0000X
Pain Medicine Physician
Primary
—
—
208VP0014X
Interventional Pain Medicine Physician
—
NULL
208VP0014X
Interventional Pain Medicine Physician
—
—
363L00000X
Nurse Practitioner
AP3760
AZ
363L00000X
Nurse Practitioner
AP8599
AZ
363LF0000X
Family Nurse Practitioner
AP8599
AZ
363LP2300X
Primary Care Nurse Practitioner
AP8599
AZ
Other
Enumeration date
05/04/2010
Last updated
10/12/2023
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