Organization
TRI-STATE MEDICAL GROUP INC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
BRYN ASBURY (OFFICE MANAGER)
(319) 526-8789
Entity
Organization
Contact information
Practice address
1603 MORGAN ST, SUITE 3, KEOKUK, IA 52632-3433
(319) 524-4300
(319) 524-4424
Mailing address
400 N 17TH ST, KEOKUK, IA 52632-3452
(319) 524-5734
(319) 524-5758
Taxonomy
Speciality
Code
Description
License number
State
208800000X
Urology Physician
Primary
18997
IA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0145888
—
IA
01
—
56343
BC/BS
IA
01
—
56343
WELLMARK
—
Enumeration date
01/13/2006
Last updated
06/17/2008
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