TRI-STATE VASCULAR GROUP PLLC NPI 1366993818

NPI Information

  • NPI: 1366993818
  • Provider Name: TRI-STATE VASCULAR GROUP, PLLC
  • Classification: Surgery - 2086S0129X
  • Specialization: Vascular Surgery
  • Entity Type: Organization
  • Address: 1401 BAILEY AVE BLDG A
    NEEDLES, CA
    ZIP 92363
  • Phone: (960) 590-0155

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NPI Details

TRI-STATE VASCULAR GROUP, PLLC is a vascular surgery surgery in Needles, CA. The provider is a surgeon with expertise in the management of surgical disorders of the blood vessels, excluding the intracranial vessels or the heart. TRI-STATE VASCULAR GROUP, PLLC NPI is 1366993818. The provider is registered as an organization entity type and is a multi-specialty group.

The provider's business location address is:

1401 BAILEY AVE BLDG A
NEEDLES, CA
ZIP 92363-103
Phone: (960) 590-0155
Fax: (760) 326-7170

The provider's authorized official is Wantzy Cooper .
The authorized official title is Owner/member Manager and has the following contact phone number (760) 590-0155.

The enumeration date for this NPI number is 10/19/2016 and was last updated on 4/8/2024.

Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

No. Taxonomy Code Taxonomy Clasification Taxonomy Specialization License Number License State Primary
12086S0129XSurgeryVascular SurgeryYes
2208D00000XGeneral PracticeNo

Other Identifiers

The following information regarding additional identifiers associated to this NPI record includes the other identifier number, identifier type, identifier state and issuer.

No. Other Provider Identifier Other Provider Identifier Type Other Provider Identifier State Other Provider Identifier Issuer
1P20421635OTHERARIZONACORPORATION REGISTRATION NUMBER
2205332MEDICAIDARIZONA

What is NPI?

NPI stands for National Provider Identifier. The NPI is a 10-digit identification number that is completely unique. The NPI number by itself does not contain any identifiable information such as a provider’s speciality or location. The NPI is assigned to individuals or organizacions for their lifespan and it is independent of key provider information type updates like a change of practices, location or speciality.

This page was last updated on: 11/21/2025

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