Tri-State Medical Group Inc

Primary specialty

General Practice PhysicianTaxonomy code 208D00000X

Legal business name

TRI-STATE MEDICAL GROUP INC

Practice address

400 N 17TH St
Keokuk, IA 52632-3452

Phone

(319) 524-5734

Fax

(319) 524-5758

NPI assigned

Jan 13, 2006

Last updated

Jul 12, 2011By 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 3

Addresses

Other identifiers 4

Locations

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

{
    "created_epoch": "1137110400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1310428800000",
    "number": "1689653016",
    "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": "400 N 17TH ST",
            "city": "KEOKUK",
            "state": "IA",
            "postal_code": "526323452",
            "telephone_number": "319-524-5734",
            "fax_number": "319-524-5758"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "TRI-STATE MEDICAL GROUP INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-01-13",
        "last_updated": "2011-07-12",
        "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": "2084P0804X",
            "taxonomy_group": "",
            "desc": "Psychiatry & Neurology, Child & Adolescent Psychiatry",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "208600000X",
            "taxonomy_group": "",
            "desc": "Surgery",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "208D00000X",
            "taxonomy_group": "",
            "desc": "General Practice",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1689653016",
            "state": "MO"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "0145888",
            "state": "IA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "WELLMARK BC/BS",
            "identifier": "56343",
            "state": "IA"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1689653016",
            "state": "IL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

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• General Practice Physician in Keokuk, IA
• Providers in Keokuk, IA by specialty
• General Practice Physician in Iowa

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 12, 2011; 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.