Provider Demographics
NPI:1346742277
Name:TRI-STATE LITHOTRIPSY III LP
Entity Type:Organization
Organization Name:TRI-STATE LITHOTRIPSY III LP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PARTNER
Authorized Official - Prefix:MR
Authorized Official - First Name:WAYNE
Authorized Official - Middle Name:
Authorized Official - Last Name:BRUCE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:806-662-5898
Mailing Address - Street 1:320 W FRANCIS AVE
Mailing Address - Street 2:
Mailing Address - City:PAMPA
Mailing Address - State:TX
Mailing Address - Zip Code:79065-6447
Mailing Address - Country:US
Mailing Address - Phone:806-669-3402
Mailing Address - Fax:
Practice Address - Street 1:320 W FRANCIS AVE
Practice Address - Street 2:
Practice Address - City:PAMPA
Practice Address - State:TX
Practice Address - Zip Code:79065-6447
Practice Address - Country:US
Practice Address - Phone:806-669-3402
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-03-07
Last Update Date:2018-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QL0400XAmbulatory Health Care FacilitiesClinic/CenterLithotripsy