Provider Demographics
NPI:1346866019
Name:TRI-STAR PRIMARY CARE LLC
Entity Type:Organization
Organization Name:TRI-STAR PRIMARY CARE LLC
Other - Org Name:TRI-STAR PRIMARY CARE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MS
Authorized Official - First Name:KATRINA
Authorized Official - Middle Name:MONTES
Authorized Official - Last Name:LEE
Authorized Official - Suffix:
Authorized Official - Credentials:APRN
Authorized Official - Phone:725-500-4645
Mailing Address - Street 1:8778 S MARYLAND PKWY STE 110
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89123-6705
Mailing Address - Country:US
Mailing Address - Phone:725-500-4645
Mailing Address - Fax:702-442-0947
Practice Address - Street 1:8778 S MARYLAND PKWY STE 110
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89123-6705
Practice Address - Country:US
Practice Address - Phone:725-500-4645
Practice Address - Fax:702-442-0947
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-06-18
Last Update Date:2022-09-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LP2300XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPrimary CareGroup - Single Specialty