Tri-State Medical Group Inc

Primary specialty

Urology PhysicianTaxonomy code 208800000X

License

18997 Issued in IA

Legal business name

TRI-STATE MEDICAL GROUP INC

Practice address

1603 Morgan St
Suite 3
Keokuk, IA 52632-3433

Phone

(319) 524-4300

Fax

(319) 524-4424

NPI assigned

Jan 13, 2006

Last updated

Jun 17, 2008By 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

Bryn Asbury

Title

Office Manager

Phone

(319) 526-8789

Specialties & licenses 1

Addresses

Other identifiers 3

Locations

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

{
    "created_epoch": "1137110400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1213660800000",
    "number": "1326027756",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "400 N 17TH ST",
            "city": "KEOKUK",
            "state": "IA",
            "postal_code": "526323452",
            "telephone_number": "319-524-5734",
            "fax_number": "319-524-5758"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1603 MORGAN ST",
            "address_2": "SUITE 3",
            "city": "KEOKUK",
            "state": "IA",
            "postal_code": "526323433",
            "telephone_number": "319-524-4300",
            "fax_number": "319-524-4424"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "TRI-STATE MEDICAL GROUP INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-01-13",
        "last_updated": "2008-06-17",
        "status": "A",
        "authorized_official_last_name": "ASBURY",
        "authorized_official_first_name": "BRYN",
        "authorized_official_title_or_position": "OFFICE MANAGER",
        "authorized_official_telephone_number": "319-526-8789"
    },
    "taxonomies": [
        {
            "code": "208800000X",
            "taxonomy_group": "",
            "desc": "Urology",
            "state": "IA",
            "license": "18997",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "0145888",
            "state": "IA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BC/BS",
            "identifier": "56343",
            "state": "IA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "WELLMARK",
            "identifier": "56343",
            "state": null
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Dwain Lee Stone, MD
• Kristin Kay Suminski, LMHC, LPC
• Elizabeth A Swanson, R.D., L.D.
• Tender Loving Home Care Services, LLC
• Katelyn Grace Thurman, APRN
• Tri-State Medical Group Inc
• Tri-State Medical Group Inc
• Tri-State Radiology, PC
• Twin Rivers Inc. (River Hills Village)
• Twin Rivers, Inc. (River Hills Village)

• Urology Physician in Keokuk, IA
• Providers in Keokuk, IA by specialty
• Urology Physician in Iowa

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 17, 2008; 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.