MEDICARE: TRISTATE SURGICAL ASSOCIATES PLLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	208G00000X	Thoracic Surgery (Cardiothoracic Vascular Surgery) Physician

General Provider Information

NPI Number	:	1467497933
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	TRISTATE SURGICAL ASSOCIATES PLLC

Provider Business Mailing Address
First Line	:	2744 SILVER CREEK RD
Second Line	:
City	:	BULLHEAD CITY
State	:	AZ
Zip	:	86442-7913
Country	:	US
Telephone Number	:	928-704-7166
Fax Number	:	928-704-7144

Provider Business Practice Location Address
First Line	:	2744 SILVERCREEK RD
Second Line	:
City	:	BULLHEAD CITY
State	:	AZ
Zip	:	86442-7913
Country	:	US
Telephone Number	:	928-704-7166
Fax Number	:	928-704-7144

Authorized Official
Title or Position	:	PHYSICIAN
Name	:	DR. JIM D. BATES
Credential	:	D.O.
Telephone Number	:	928-704-7166

Provider Enumeration Date	:	06/18/2006
Last Update Date	:	01/29/2008

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