Tri State Medical Alliance LLC
NPI #1518472950 in Fort Mohave, Arizona
Provider Information
- NPI Number
- 1518472950
- Entity Type
- Organization
- Organization Name
- Tri State Medical Alliance LLC
- Primary Specialty
- Clinic/Center - Radiology
- Enumeration Date
- Dec 7, 2017
- Last Updated
- Nov 3, 2023
Practice Location
- Address
- 1510 E WAGON WHEEL LN STE 103
- City
- Fort Mohave
- State
- Arizona
- ZIP Code
- 86426-6698
- Phone
- (928) 460-7226
Authorized Official
- Name
- HANZ TABORA, PT, DPT, FAAOMPT
- Title
- OWNER/MEMBER MANAGER
- Phone
- (928) 460-7226
Specialties & Taxonomy Codes
| Specialty |
|---|
| Physiological Laboratory |
| Clinic/Center - Radiology — Radiology |
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