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Organization
TRI-STATE MEDICAL SPECIALISTS LLC
Active
Organization
TRI-STATE MEDICAL SPECIALISTS LLC
Active
Other names
Tri-State Pain Institute
Organization subpart
No
Provider details
NPI number
Authorized official
JOANN VENGER (OWNER/MEMBER MANAGER)
(928) 788-3333
Entity
Organization
Contact information
Practice address
9555 SOUTH EASTERN AVENUE, STE. 210, HENDERSON, NV 89121
(928) 788-3333
(928) 788-3555
Mailing address
PO BOX 10966, FORT MOHAVE, AZ 86427-0966
(928) 788-3333
(928) 788-3555
Taxonomy
Speciality
Code
Description
License number
State
207T00000X
Neurological Surgery Physician
—
—
208100000X
Physical Medicine & Rehabilitation Physician
—
—
208VP0000X
Pain Medicine Physician
Primary
—
—
208VP0014X
Interventional Pain Medicine Physician
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1649598426
—
NV
Enumeration date
10/25/2018
Last updated
07/19/2022
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