Tri State Immunization Group Inc

Primary specialty

Registered NurseTaxonomy code 163W00000X

Legal business name

TRI STATE IMMUNIZATION GROUP INC

Doing business as

Passport Health of Evansville

Practice address

101 Plaza East Boulevard
Ste 107
Evansville, IN 47715-2804

Phone

(812) 402-6000

Fax

(812) 402-6012

NPI assigned

Jun 28, 2013

Organization subpart

No

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

Authorized official

Name

Scott R Burgess

Title

Owner

Phone

(812) 402-6000

Specialties & licenses 1

Addresses

Other names 1

• Passport Health of Evansville Doing business as

Locations

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

{
    "created_epoch": "1372377600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1372464000000",
    "number": "1477993939",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "101 PLAZA EAST BLVD",
            "address_2": "STE 107",
            "city": "EVANSVILLE",
            "state": "IN",
            "postal_code": "477152804",
            "telephone_number": "812-402-6000",
            "fax_number": "812-402-6012"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "101 PLAZA EAST BOULEVARD",
            "address_2": "STE 107",
            "city": "EVANSVILLE",
            "state": "IN",
            "postal_code": "477152804",
            "telephone_number": "812-402-6000",
            "fax_number": "812-402-6012"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "TRI STATE IMMUNIZATION GROUP INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2013-06-28",
        "last_updated": "2013-06-29",
        "status": "A",
        "authorized_official_last_name": "BURGESS",
        "authorized_official_first_name": "SCOTT",
        "authorized_official_middle_name": "R",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "812-402-6000"
    },
    "taxonomies": [
        {
            "code": "163W00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Registered Nurse",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Passport Health of Evansville",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Olivia Treski
• Jayme A Trevino, MSW LCSW
• Karen Trevino, M.D.
• Meghan Elizabeth Trevino, LCSW
• Tri State Community Clinic, LLC
• Tri State Internal Medicine Source
• Tri State RX, LLC (Nation's Medicines)
• Tri State Transportation (Metro Ride)
• Tri-State Anesthesiologists, PC
• Tri-State Arthritis & Rheumatology Center, LLC

• Registered Nurse in Evansville, IN
• Providers in Evansville, IN by specialty
• Registered Nurse in Indiana

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 29, 2013; 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.