# TRI-STATE MEDICAL GROUP INC

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

## Provider details

- **NPI number:** 1922186006
- **Authorized official:** MR. ALLAN W. ZASTROW (CEO)
- **Authorized official phone:** (319) 524-7150

## Contact information

- **Practice address:** 1603 MORGAN ST, SUITE 7, KEOKUK, IA 52632-3433
- **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 |
| --- | --- | --- | --- | --- |
| 207Q00000X | Family Medicine Physician | 25523 | IA | Yes |

## Other

- **Enumeration date:** 11/02/2006
- **Last updated:** 06/17/2008