MEDICARE: TRI-STATE NEURO-SPINE INSTITUTE, P.L.C.

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	207T00000X	Neurological Surgery Physician	34280	AZ

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1518935956
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	TRI-STATE NEURO-SPINE INSTITUTE, P.L.C.

Provider Business Mailing Address
First Line	:	5300 S HIGHWAY 95
Second Line	:	SUITE C
City	:	FORT MOHAVE
State	:	AZ
Zip	:	86426-9251
Country	:	US
Telephone Number	:	928-770-4515
Fax Number	:	928-770-4518

Provider Business Practice Location Address
First Line	:	5300 S HIGHWAY 95
Second Line	:	SUITE C
City	:	FORT MOHAVE
State	:	AZ
Zip	:	86426-9251
Country	:	US
Telephone Number	:	928-770-4515
Fax Number	:	928-770-4518

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DR. ISAAC MARTIN THAPEDI
Credential	:	M.D.
Telephone Number	:	928-770-4515

Provider Enumeration Date	:	03/10/2006
Last Update Date	:	09/09/2013

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