Provider Demographics
NPI:1346597903
Name:TRI-STAR PEDIATRICS SERVICES CO
Entity Type:Organization
Organization Name:TRI-STAR PEDIATRICS SERVICES CO
Other - Org Name:TRI-STAR PEDIATRICS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MR
Authorized Official - First Name:FIL
Authorized Official - Middle Name:QUIMBO
Authorized Official - Last Name:ALMENARIO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:702-558-3551
Mailing Address - Street 1:2510 WIGWAM PKWY
Mailing Address - Street 2:SUITE 103
Mailing Address - City:HENDERSON
Mailing Address - State:NV
Mailing Address - Zip Code:89074-7115
Mailing Address - Country:US
Mailing Address - Phone:702-558-3551
Mailing Address - Fax:702-361-0983
Practice Address - Street 1:2510 WIGWAM PKWY
Practice Address - Street 2:SUITE 103
Practice Address - City:HENDERSON
Practice Address - State:NV
Practice Address - Zip Code:89074-7115
Practice Address - Country:US
Practice Address - Phone:702-558-3551
Practice Address - Fax:702-361-0983
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-08-13
Last Update Date:2012-08-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV10073208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Single Specialty