Tri State Medical Alliance Llc
LBN: Tri State Medical Alliance Llc
Tri State Medical Alliance Llc is an health care organization with primary practice located at 1510 E Wagon Wheel Ln Ste 103 , Fort Mohave AZ 86426-6698. The organization recently has 2 registered licenses in different health care specialties including Ambulatory Health Care Facilities / Radiology, Laboratories / Physiological Laboratory. Ambulatory Health Care Facilities / Radiology is the primary health care specialty.
Tri State Medical Alliance Llc can be contacted via phone (928) 460-7226, or through Tabora, Hanz via phone (928) 460-7226.
Contact Information
Primary practice address
1510 E Wagon Wheel Ln Ste 103
Fort Mohave AZ 86426-6698
Phone: (928) 460-7226
Fax: (928) 447-6113
Website:
Health care specialties
| Specialty | Code | License # | State |
|---|---|---|---|
| Ambulatory Health Care Facilities / Radiology | 261QR0200X | ||
| Laboratories / Physiological Laboratory | 293D00000X |
Profile Details
| NPI number | 1518472950 |
|---|---|
| LBN Legal business name | Tri State Medical Alliance Llc |
| DBA Doing business as | |
| Authorized official | Tabora, Hanz PT, DPT, FAAOMPT |
| Entity | Organization |
| Organization subpart 1 | No |
| Enumeration date | Dec 7th, 2017 |
| Last updated | Nov 3rd, 2023 - about 3 years ago |
1 Some organizations, which are providing health care services, may consist of units or departments that provide different types of health care services or have several separate physical locations, where health care service is provided. These units, departments or physical locations are not themselves legal entities. However, each of them is part of the organization, which is a legal entity. The organization may decide whether its subparts, if it has any, should have their own NPI numbers. In case a subpart conducts any HIPAA standard transactions by itself, without its parent's involvement, it must have its own NPI number.
Identifiers
| State | Type | Number | Issuer |
|---|---|---|---|
| All States | NPI | 1518472950 | NPPES |
| Arizona | Other | L22382013 | CORPORATION ID# |
| Arizona | MEDICAID | 557885 | CORPORATION ID# |
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