# TRI-STATE MEDICAL SPECIALISTS LLC

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- **Entity:** Organization
- **Status:** Active
- **Other names:** TriState Pain Institute
- **Organization subpart:** No

## Provider details

- **NPI number:** 1649598426
- **Authorized official:** KNAYA TABORA (OWNER/MEMBER MANAGER)
- **Authorized official phone:** (928) 788-3333

## Contact information

- **Practice address:** 1510 E WAGON WHEEL LN STE 110, FORT MOHAVE, AZ 86426-6698
- **Practice address phone:** (928) 788-3333
- **Practice address fax:** (928) 788-3555
- **Mailing address:** 1510 E WAGON WHEEL LN STE 110, FORT MOHAVE, AZ 86426-6698
- **Mailing address phone:** (928) 788-3333
- **Mailing address fax:** (928) 788-3555

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 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 | — | NULL | Yes |
| 208VP0000X | Pain Medicine Physician | — | — | Yes |
| 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