Provider Demographics
NPI:1326557398
Name:TRISTAR DIAGNOSTICS LABORATORIES
Entity Type:Organization
Organization Name:TRISTAR DIAGNOSTICS LABORATORIES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:DARRYLLE
Authorized Official - Middle Name:M
Authorized Official - Last Name:KEVIANNE
Authorized Official - Suffix:II
Authorized Official - Credentials:LVN
Authorized Official - Phone:972-885-8172
Mailing Address - Street 1:1339 RIDGEVIEW DR
Mailing Address - Street 2:
Mailing Address - City:CEDAR HILL
Mailing Address - State:TX
Mailing Address - Zip Code:75104-6234
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1339 RIDGEVIEW DR
Practice Address - Street 2:
Practice Address - City:CEDAR HILL
Practice Address - State:TX
Practice Address - Zip Code:75104-6234
Practice Address - Country:US
Practice Address - Phone:972-885-8172
Practice Address - Fax:214-602-6172
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-09-21
Last Update Date:2017-09-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory