Tri-State OB-GYN PC

Primary specialty

Obstetrics & Gynecology PhysicianTaxonomy code 207V00000X

Legal business name

TRI-STATE OB-GYN PC

Practice address

3003 Highway 95
Ste 31
Bullhead City, AZ 86442-7860

Phone

(928) 704-2229

Fax

(928) 704-2255

NPI assigned

Sep 20, 2006

Last updated

Aug 22, 2020By the provider in NPPES

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Theodore London, MD

Title

President

Phone

(928) 704-2229

Specialties & licenses 1

Addresses

Locations

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1158710400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1063510204",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3003 HIGHWAY 95",
            "address_2": "STE 31",
            "city": "BULLHEAD CITY",
            "state": "AZ",
            "postal_code": "864427860",
            "telephone_number": "928-704-2229",
            "fax_number": "928-704-2255"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3003 HIGHWAY 95",
            "address_2": "STE 31",
            "city": "BULLHEAD CITY",
            "state": "AZ",
            "postal_code": "864427860",
            "telephone_number": "928-704-2229",
            "fax_number": "928-704-2255"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "TRI-STATE OB-GYN PC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-09-20",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "LONDON",
        "authorized_official_first_name": "THEODORE",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "928-704-2229",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "207V00000X",
            "taxonomy_group": "",
            "desc": "Obstetrics & Gynecology",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Obstetrics & Gynecology Physician in Bullhead City, AZ
• Providers in Bullhead City, AZ by specialty
• Obstetrics & Gynecology Physician in Arizona

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 22, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.