Healthcare Provider Details

I. General information

NPI: 1902134406
Provider Name (Legal Business Name): TRI-STATE SPECIALISTS, LLP
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/23/2009
Last Update Date: 10/09/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2730 PIERCE ST STE 300
SIOUX CITY IA
51104-3765
US

IV. Provider business mailing address

2730 PIERCE ST STE 300
SIOUX CITY IA
51104-3765
US

V. Phone/Fax

Practice location:
  • Phone: 712-224-8677
  • Fax: 712-277-1662
Mailing address:
  • Phone: 712-224-8677
  • Fax: 712-277-1662

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code207XS0106X
TaxonomyOrthopaedic Hand Surgery Physician
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code207XS0117X
TaxonomyOrthopaedic Surgery of the Spine Physician
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code207XX0005X
TaxonomySports Medicine (Orthopaedic Surgery) Physician
License Number
License Number State
# 5
Primary TaxonomyN
Taxonomy Code208200000X
TaxonomyPlastic Surgery Physician
License Number
License Number State
# 6
Primary TaxonomyN
Taxonomy Code2084N0400X
TaxonomyNeurology Physician
License Number
License Number State
# 7
Primary TaxonomyN
Taxonomy Code363AS0400X
TaxonomySurgical Physician Assistant
License Number
License Number State

VIII. Authorized Official

Name: DUANE K NELSON
Title or Position: PRESIDENT
Credential: M.D.
Phone: 712-224-8677