# TRI-STATE MEDICAL GROUP INC

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1689653016
- **Authorized official:** BRYN ASBURY (OFFICE MANAGER)
- **Authorized official phone:** (319) 526-8789

## Contact information

- **Practice address:** 400 N 17TH ST, KEOKUK, IA 52632-3452
- **Practice address phone:** (319) 524-5734
- **Practice address fax:** (319) 524-5758
- **Mailing address:** 400 N 17TH ST, KEOKUK, IA 52632-3452
- **Mailing address phone:** (319) 524-5734
- **Mailing address fax:** (319) 524-5758

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 2084P0804X | Child & Adolescent Psychiatry Physician | — | — | — |
| 208600000X | Surgery Physician | — | — | — |
| 208D00000X | General Practice Physician | — | — | Yes |

## Other

- **Enumeration date:** 01/13/2006
- **Last updated:** 07/12/2011

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 05 | — | 0145888 | — | IA |
| 05 | — | 1689653016 | — | IL |
| 05 | — | 1689653016 | — | MO |
| 01 | — | 56343 | WELLMARK BC/BS | IA |