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TRISTATE PAIN INSTITUTE
NPI 1023302643
Non-Pharmacy Dispensing Site in Fort Mohave, AZ

Active since May 31, 2011CLIA 03D2004513 · Waiver
1510 WAGON WHEEL LANE, SUITE 110, FORT MOHAVE, AZ 86426(928) 788-3333(928) 788-3555 Get Directions Write a Review

NPPES record last updated: July 19, 2022. Verified against the NPPES registry weekly; last sync: September 06, 2026.

Record update history: Jul 19, 2022, Mar 2, 2016 (2 updates tracked since 2016).

About Tristate Pain Institute NPPES

Official registry information on file with the National Plan and Provider Enumeration System.

TRISTATE PAIN INSTITUTE (NPI 1023302643) is a healthcare organization registered as a non-pharmacy dispensing site in Fort Mohave, Arizona and active in the NPI registry since May 2011. The organization holds a CLIA Waiver certificate valid through September 23, 2028 and lists Joann Venger, Owner, as its authorized official.

NPPES Registry Identity

NPI1023302643
Entity TypeOrganization
Primary Taxonomy332900000X
Legal Business NameTRI-STATE MEDICAL SPECIALISTS LLC
Location Address1510 WAGON WHEEL LANE, SUITE 110Fort Mohave, AZ 86426-6698
Mailing AddressPo Box 10966Fort Mohave, AZ 86427-0966 · (928) 788-3333 · Fax (928) 788-3555
Phone(928) 788-3333
Fax(928) 788-3555
Organization SubpartYes
Authorized OfficialJoann VengerOwner · (928) 788-3333
Enumeration DateMay 31, 2011
Last NPPES UpdateJuly 19, 20222 updates tracked since enumeration
NPPES CertifiedJuly 19, 2022
✔ NPI 1023302643 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtyNon-Pharmacy Dispensing SiteSuppliers
Taxonomy Code332900000X
Definition
A site other than a pharmacy that dispenses medicinal preparations under the supervision of a physician to patients for self-administration. (e.g. physician offices, ER, Urgent Care Centers, Rural Health Facilities, etc.)
1510 WAGON WHEEL LANE, Fort Mohave, AZ 86426
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Other Names 1

Doing Business AsTristate Pain Institute

CLIA Laboratory Certificates CMS CLIA

Laboratory certificates issued under the Clinical Laboratory Improvement Amendments (CLIA) program, which sets federal quality standards for human laboratory testing in the United States. There is no official CMS crosswalk between CLIA and NPI numbers; these certificates are associated with this NPI by matching facility names, locations and phone numbers in the CMS CLIA registry.

Certificate of Waiver 03D2004513

Tri-State Medical Specialists, LLC · Fort Mohave, AZ
Active · expires Sep 23, 2028
CLIA Number03D2004513
Laboratory TypePhysician Office
Certificate Effective DateSeptember 24, 2026
Certificate Expiration DateSeptember 23, 2028
Laboratory DirectorNitish Aggarwal
Laboratory Phone(928) 788-3333
Laboratory LocationTri-State Medical Specialists, LLC1510 Wagon Wheel Lane, Ste 110, Fort Mohave, AZ 86426
CLIA data matches this NPI record on: Address Name Phone
This certificate is issued to a laboratory to perform only waived tests.

Frequently Asked Questions NPPES & CMS

Common questions about this NPI record, answered from the official NPPES registry and CMS datasets shown on this page.

What is Tri-State Medical Specialists LLC's NPI number?

The NPI number for Tri-State Medical Specialists LLC is 1023302643. It was assigned to this organization in the NPPES registry on May 31, 2011. The provider is doing business as Tristate Pain Institute.

Where is Tri-State Medical Specialists LLC located?

Tri-State Medical Specialists LLC is located at 1510 Wagon Wheel Lane Suite 110, Fort Mohave, AZ 86426. The listed phone number is (928) 788-3333.

What is Tri-State Medical Specialists LLC's specialty?

The primary specialty registered for this NPI is Non-Pharmacy Dispensing Site with taxonomy code 332900000X.

Does Tri-State Medical Specialists LLC hold a CLIA laboratory certificate?

Yes. A Certificate of Waiver (number 03D2004513) is associated with this NPI, valid through September 23, 2028. CLIA certificates authorize laboratory testing under the federal Clinical Laboratory Improvement Amendments program.

When was this NPI record last updated?

The NPPES record for Tri-State Medical Specialists LLC was last updated on July 19, 2022. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 4 years ago. If this record has changed at CMS more recently, you can request an on-demand re-check against the live CMS registry, directly from this page.