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TRI-STATE VASCULAR GROUP, PLLC
NPI 1366993818
Surgery - Vascular Surgery in Needles, CA

Active since October 19, 2016
1401 BAILEY AVE BLDG A, NEEDLES, CA 92363(960) 590-0155(760) 326-7170 Get Directions Write a Review

NPPES record last updated: April 8, 2024. Verified against the NPPES registry weekly; last sync: July 26, 2026.

Record update history: Apr 8, 2024, Feb 19, 2020, Oct 19, 2016 (3 updates tracked since 2016).

About Tri-state Vascular Group, Pllc NPPES

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

TRI-STATE VASCULAR GROUP, PLLC (NPI 1366993818) is a healthcare organization registered as a vascular surgery in Needles, California and active in the NPI registry since October 2016. The organization lists Wantzy Cooper, Owner/member Manager, as its authorized official.

NPPES Registry Identity

NPI1366993818
Entity TypeOrganization
Primary Taxonomy2086S0129X
Legal Business NameTRI-STATE VASCULAR GROUP, PLLC
Location Address1401 BAILEY AVE BLDG ANeedles, CA 92363-3103
Mailing AddressPo Box 9893Fort Mohave, AZ 86427-9893 · (928) 788-4944 · Fax (928) 788-4949
Phone(960) 590-0155
Fax(760) 326-7170
Organization SubpartNo
Authorized OfficialWantzy CooperOwner/member Manager · (760) 590-0155
Enumeration DateOctober 19, 2016
Last NPPES UpdateApril 8, 20243 updates tracked since enumeration
NPPES CertifiedApril 8, 2024
✔ NPI 1366993818 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses 2

★ Primary SpecialtySurgery · Vascular SurgeryAllopathic & Osteopathic Physicians
Taxonomy Code2086S0129X
Definition

A surgeon with expertise in the management of surgical disorders of the blood vessels, excluding the intracranial vessels or the heart.

Also ListedGeneral PracticeTaxonomy 208D00000X
1401 BAILEY AVE BLDG A, Needles, CA 92363
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Other Identifiers 2

OtherP20421635AZ · Corporation Registration Number
Medicaid205332AZ

Group Practice 1

Group TaxonomyThis provider is a business group of one or more individual practitioners, who practice with different areas of specialization.193200000X MULTI-SPECIALTY GROUP

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 Vascular Group, PLLC's NPI number?

The NPI number for Tri-State Vascular Group, PLLC is 1366993818. It was assigned to this organization in the NPPES registry on October 19, 2016.

Where is Tri-State Vascular Group, PLLC located?

Tri-State Vascular Group, PLLC is located at 1401 Bailey Ave Bldg A, Needles, CA 92363. The listed phone number is (960) 590-0155.

What is Tri-State Vascular Group, PLLC's specialty?

The primary specialty registered for this NPI is Surgery, specializing in Vascular Surgery, with taxonomy code 2086S0129X.

When was this NPI record last updated?

The NPPES record for Tri-State Vascular Group, PLLC was last updated on April 8, 2024. NPI Profile syncs with the weekly NPPES data releases published by CMS.