Provider Demographics
NPI:1518935956
Name:TRI-STATE NEURO-SPINE INSTITUTE, P.L.C.
Entity Type:Organization
Organization Name:TRI-STATE NEURO-SPINE INSTITUTE, P.L.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:ISAAC
Authorized Official - Middle Name:MARTIN
Authorized Official - Last Name:THAPEDI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:928-770-4515
Mailing Address - Street 1:5300 S HIGHWAY 95
Mailing Address - Street 2:SUITE C
Mailing Address - City:FORT MOHAVE
Mailing Address - State:AZ
Mailing Address - Zip Code:86426-9251
Mailing Address - Country:US
Mailing Address - Phone:928-770-4515
Mailing Address - Fax:928-770-4518
Practice Address - Street 1:5300 S HIGHWAY 95
Practice Address - Street 2:SUITE C
Practice Address - City:FORT MOHAVE
Practice Address - State:AZ
Practice Address - Zip Code:86426-9251
Practice Address - Country:US
Practice Address - Phone:928-770-4515
Practice Address - Fax:928-770-4518
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-03-10
Last Update Date:2013-09-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ34280207T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207T00000XAllopathic & Osteopathic PhysiciansNeurological SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ964735Medicaid
AZ6794320001Medicare NSC
AZC41723Medicare UPIN
AZ964735Medicaid