Tri State Internal Medicine Source

Primary specialty

Internal Medicine PhysicianTaxonomy code 207R00000X

Legal business name

TRI STATE INTERNAL MEDICINE SOURCE

Practice address

3700 Bellemeade Ave
Ste 119
Evansville, IN 47714-0102

Phone

(812) 477-4375

Fax

(812) 477-3375

NPI assigned

Aug 12, 2010

Organization subpart

No

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

Authorized official

Name

Kelly L Kling-Tipton, MD

Title

Owner

Phone

(812) 477-4375

Specialties & licenses 1

Addresses

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

{
    "created_epoch": "1281571200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1281571200000",
    "number": "1255646485",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3700 BELLEMEADE AVE",
            "address_2": "STE 119",
            "city": "EVANSVILLE",
            "state": "IN",
            "postal_code": "477140102",
            "telephone_number": "812-477-4375",
            "fax_number": "812-477-3375"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3700 BELLEMEADE AVE",
            "address_2": "STE 119",
            "city": "EVANSVILLE",
            "state": "IN",
            "postal_code": "477140102",
            "telephone_number": "812-477-4375",
            "fax_number": "812-477-3375"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "TRI STATE INTERNAL MEDICINE SOURCE",
        "organizational_subpart": "NO",
        "enumeration_date": "2010-08-12",
        "last_updated": "2010-08-12",
        "status": "A",
        "authorized_official_last_name": "KLING-TIPTON",
        "authorized_official_first_name": "KELLY",
        "authorized_official_middle_name": "L",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "812-477-4375",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Internal Medicine",
            "state": "IN",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Jayme A Trevino, MSW LCSW
• Karen Trevino, M.D.
• Meghan Elizabeth Trevino, LCSW
• Tri State Community Clinic, LLC
• Tri State Immunization Group Inc
• Tri State RX, LLC
• Tri State Transportation
• Tri-State Anesthesiologists, PC
• Tri-State Arthritis & Rheumatology Center, LLC
• Tri-State Colorectal Group, LLC

• Internal Medicine Physician in Evansville, IN
• Providers in Evansville, IN by specialty
• Internal Medicine Physician in Indiana

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 12, 2010; 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.