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General NPI Number Information
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NPI Number | 1225543036
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Entity Type | Organization
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Legal Business Name | TRI-STATE SINUS CENTER
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Dates
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Enumeration Date | 12/04/2017
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Last Update Date | 12/04/2017
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Provider Practice Location Address
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Address Line | 2020 SILVER CREEK B101
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City | BULLHEAD CITY
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State | AZ
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Zip | 86442
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Country | US
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Telephone | 406-836-2484
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Fax |
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Provider Business Mailing Address
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Address Line | 896 TALON POINTE DR
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City | BULLHEAD CITY
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State | AZ
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Zip | 86429-5225
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | CEO
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Name | CAREY SIMS
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Credential |
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Telephone | 406-836-2484
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Y00000X
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Taxonomy Name | Otolaryngology Physician
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License Number |
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License Number State |
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