Provider Demographics
NPI:1467497933
Name:TRISTATE SURGICAL ASSOCIATES PLLC
Entity Type:Organization
Organization Name:TRISTATE SURGICAL ASSOCIATES PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:JIM
Authorized Official - Middle Name:D
Authorized Official - Last Name:BATES
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:928-704-7166
Mailing Address - Street 1:2744 SILVER CREEK RD
Mailing Address - Street 2:
Mailing Address - City:BULLHEAD CITY
Mailing Address - State:AZ
Mailing Address - Zip Code:86442-7913
Mailing Address - Country:US
Mailing Address - Phone:928-704-7166
Mailing Address - Fax:928-704-7144
Practice Address - Street 1:2744 SILVERCREEK RD
Practice Address - Street 2:
Practice Address - City:BULLHEAD CITY
Practice Address - State:AZ
Practice Address - Zip Code:86442-7913
Practice Address - Country:US
Practice Address - Phone:928-704-7166
Practice Address - Fax:928-704-7144
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-18
Last Update Date:2008-01-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208G00000XAllopathic & Osteopathic PhysiciansThoracic Surgery (Cardiothoracic Vascular Surgery)Group - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZZ80028Medicare PIN