Provider Demographics
NPI:1871531426
Name:TRI-STATE ORTHOPAEDICS, LLC
Entity type:Organization
Organization Name:TRI-STATE ORTHOPAEDICS, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:APURVA
Authorized Official - Middle Name:RASHMIKANT
Authorized Official - Last Name:DALAL
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:901-333-2525
Mailing Address - Street 1:PO BOX 397
Mailing Address - Street 2:
Mailing Address - City:MEMPHIS
Mailing Address - State:TN
Mailing Address - Zip Code:38101-0397
Mailing Address - Country:US
Mailing Address - Phone:901-346-5488
Mailing Address - Fax:901-346-4774
Practice Address - Street 1:1264 WESLEY DR
Practice Address - Street 2:SUITE 502
Practice Address - City:MEMPHIS
Practice Address - State:TN
Practice Address - Zip Code:38116
Practice Address - Country:US
Practice Address - Phone:901-333-2525
Practice Address - Fax:901-786-6635
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-04
Last Update Date:2018-08-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN34477207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN3713370Medicaid
AR150677002Medicaid
MSC04517Medicare PIN
TN3713370Medicare PIN
TN3713370Medicaid