MEDICARE: TRI-STATE MEDICAL SPECIALISTS LLC

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	207LP2900X	Pain Medicine (Anesthesiology) Physician
2	207T00000X	Neurological Surgery Physician	20605	AZ
3	207T00000X	Neurological Surgery Physician	5573	NY
4	2081P2900X	Pain Medicine (Physical Medicine & Rehabilitation) Physician
5	208VP0000X	Pain Medicine Physician	20605	AZ
6	208VP0000X	Pain Medicine Physician	5573	NV
7	208VP0014X	Interventional Pain Medicine Physician
8	363L00000X	Nurse Practitioner	AP8599	AZ
9	363L00000X	Nurse Practitioner	AP3760	AZ
10	363LF0000X	Family Nurse Practitioner	AP8599	AZ
11	363LP2300X	Primary Care Nurse Practitioner	AP8599	AZ
12	208VP0000X	Pain Medicine Physician

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
2	DQ4807	OTHER	AZ	MEDICARE RAILROAD GROUP PIN

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	:	1649598426
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	TRI-STATE MEDICAL SPECIALISTS LLC

Provider Business Mailing Address
First Line	:	1510 E WAGON WHEEL LN STE 110
Second Line	:
City	:	FORT MOHAVE
State	:	AZ
Zip	:	86426-6698
Country	:	US
Telephone Number	:	928-788-3333
Fax Number	:	928-788-3555

Provider Business Practice Location Address
First Line	:	1510 E WAGON WHEEL LN STE 110
Second Line	:
City	:	FORT MOHAVE
State	:	AZ
Zip	:	86426-6698
Country	:	US
Telephone Number	:	928-788-3333
Fax Number	:	928-788-3555

Authorized Official
Title or Position	:	OWNER/MEMBER MANAGER
Name	:	KNAYA TABORA
Credential	:
Telephone Number	:	928-788-3333

Provider Enumeration Date	:	05/04/2010
Last Update Date	:	10/12/2023

Similar Medicare Providers

1427482991 — DR. RHENAND MENDOZA PT, DPT
Practice Location Address:

1510 E WAGON WHEEL LN STE 110
FORT MOHAVE, AZ
86426-6698

Practice Phone: 928-248-0444
Practice Fax: 928-248-0443

1780804583 — WILLIAM R KELLEY MD PROF CORP
Practice Location Address:

1510 E WAGON WHEEL LN STE 110
FORT MOHAVE, AZ
86426-6698

Practice Phone: 928-788-3333
Practice Fax: 928-788-3555

1023302643 — TRI-STATE MEDICAL SPECIALISTS LLC
Practice Location Address:

1510 WAGON WHEEL LANE , SUITE 110
FORT MOHAVE, AZ
86426-6698

Practice Phone: 928-788-3333
Practice Fax: 928-788-3555

1861891897 — HANZ K TABORA P.T., DPT, FAAOMPT
Practice Location Address:

1510 E WAGON WHEEL LN STE 102
FORT MOHAVE, AZ
86426-6698

Practice Phone: 904-994-5560
Practice Fax:

1396109385 — ARIS P. PARAGUYA MD
Practice Location Address:

1510 E WAGON WHEEL LN STE 104
FORT MOHAVE, AZ
86426-6698

Practice Phone: 928-889-2273
Practice Fax: 928-212-1355

1477072130 — OKEY ILOEGBUNAM FNP
Practice Location Address:

1510 E WAGON WHEEL LN STE 110
FORT MOHAVE, AZ
86426-6698

Practice Phone: 928-788-3333
Practice Fax: 928-788-3555

Directions to “TRI-STATE MEDICAL SPECIALISTS LLC ” Practice Location

Language	Start Address	Practice Location

These directions are for planning purposes only. You may find that construction projects, traffic, or other events may cause road conditions to differ from the map results.

Copyright © 2007-2026 (Powered by Swiss Vault Engine), all rights reserved. HIPAA liability, trademark, document use and software licensing rules apply. All registered trademarks, used in the content, are the property of their owners. Your interactions with this site are in accordance with our Terms of Use and Privacy Policy.