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General NPI Number Information
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NPI Number | 1053359430
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Entity Type | Organization
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Legal Business Name | TRI STATE ANESTHESIA ASSOCIATES PLC
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Dates
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Enumeration Date | 06/04/2006
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Last Update Date | 09/27/2012
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Provider Practice Location Address
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Address Line | 2735 SILVER CREEK RD
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City | BULLHEAD CITY
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State | AZ
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Zip | 86442-7924
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Country | US
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Telephone | 928-763-2273
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 7096
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City | STOCKTON
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State | CA
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Zip | 95267-0096
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Country | US
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Telephone | 209-956-7725
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Fax | 209-956-7733
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Authorized Official
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Title or Position | GROUP PRESIDENT
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Name | MR. HERMAN V WARD
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Credential | MD
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Telephone | 928-763-2273
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207LP2900X
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Taxonomy Name | Pain Medicine (Anesthesiology) Physician
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 207L00000X
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Taxonomy Name | Anesthesiology Physician
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License Number |
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License Number State |
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