Tri State Primary Care | |
1510 E Wagon Wheel Ln Ste 104 Fort Mohave AZ 86426-6698 | |
(928) 248-0518 | |
(928) 514-2823 |
Full Name | Tri State Primary Care |
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Speciality | Internal Medicine |
Location | 1510 E Wagon Wheel Ln Ste 104, Fort Mohave, Arizona |
Authorized Official Name and Position | Wantzy Cooper (PRESIDENT) |
Authorized Official Contact | 9282480518 |
Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
Mailing Address | Practice Location Address |
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Tri State Primary Care 1510 E Wagon Wheel Ln Ste 104 Fort Mohave AZ 86426-6698 Ph: (928) 248-0518 | Tri State Primary Care 1510 E Wagon Wheel Ln Ste 104 Fort Mohave AZ 86426-6698 Ph: (928) 248-0518 |
NPI Number | 1669146536 |
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Provider Enumeration Date | 08/04/2021 |
Last Update Date | 03/04/2024 |
Medicare PECOS PAC ID | 2668863200 |
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Medicare Enrollment ID | O20240227004341 |
Identifier | Type | State | Issuer |
---|---|---|---|
1669146536 | NPI | - | NPPES |
Taxonomy | Type | License (State) | Status |
---|---|---|---|
207R00000X | Internal Medicine | (* (Not Available)) | Primary |
261QP2300X | Clinic/center - Primary Care | (* (Not Available)) | Secondary |
Provider Name | Guillermo G Zegarra |
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Provider Type | Practitioner - Internal Medicine |
Provider Identifiers | NPI Number: 1568478493 PECOS PAC ID: 1456391564 Enrollment ID: I20050509000540 |
Provider Name | Wantzy Cooper |
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Provider Type | Practitioner - Vascular Surgery |
Provider Identifiers | NPI Number: 1942383393 PECOS PAC ID: 6002815214 Enrollment ID: I20110208000789 |
Provider Name | John Adan |
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Provider Type | Practitioner - Cardiovascular Disease (cardiology) |
Provider Identifiers | NPI Number: 1295709665 PECOS PAC ID: 5799747002 Enrollment ID: I20141114000312 |
Vista Health Mirza Md Pc Primary Care Clinic Medicare: Medicare Enrolled Practice Location: 5653 S Highway 95, Ste A, Fort Mohave, AZ 86426 Phone: 928-768-2558 Fax: 928-768-2874 | |
Mohave Family Healthcare Primary Care Clinic Medicare: Medicare Enrolled Practice Location: 1611 E Joy Ln, Fort Mohave, AZ 86426 Phone: 928-768-9496 Fax: 928-768-1943 | |
Kaye A Cunningham Md Pc Primary Care Clinic Medicare: Not Enrolled in Medicare Practice Location: 5653 Hwy 95, Suite A, Fort Mohave, AZ 86426 Phone: 928-768-2558 Fax: 928-788-2039 | |
Gi Institute Of Arizona Primary Care Clinic Medicare: Not Enrolled in Medicare Practice Location: 1520 E Hammer Ln Ste 101, Fort Mohave, AZ 86426 Phone: 928-768-4333 Fax: 928-768-4338 | |
Grapevine Clinic Llc Primary Care Clinic Medicare: Medicare Enrolled Practice Location: 5300 S Highway 95, Suite H, Fort Mohave, AZ 86426 Phone: 928-788-6060 Fax: 928-788-6062 | |
Blue River Health & Wellness, Pllc Primary Care Clinic Medicare: Medicare Enrolled Practice Location: 1520 E Hammer Ln Ste 104, Fort Mohave, AZ 86426 Phone: 602-315-0211 | |
Hendrix Family Medicine Primary Care Clinic Medicare: Not Enrolled in Medicare Practice Location: 1611 Joy Ln, Fort Mohave, AZ 86426 Phone: 928-788-1900 Fax: 928-788-2048 |