Provider Demographics
NPI:1366488470
Name:TRI CITY MEDICAL SPECIALISTS LLC
Entity Type:Organization
Organization Name:TRI CITY MEDICAL SPECIALISTS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIEF EXECUTIVE OFFICER
Authorized Official - Prefix:DR
Authorized Official - First Name:DARREN
Authorized Official - Middle Name:RANDOLPH
Authorized Official - Last Name:SWENSON
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:702-839-0946
Mailing Address - Street 1:10777 W TWAIN AVENUE
Mailing Address - Street 2:SUITE 225
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89135
Mailing Address - Country:US
Mailing Address - Phone:702-839-0946
Mailing Address - Fax:702-839-0149
Practice Address - Street 1:2365 REYNOLDS AVENUE
Practice Address - Street 2:BLDG C 2ND FLOOR
Practice Address - City:N LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89030
Practice Address - Country:US
Practice Address - Phone:702-588-7070
Practice Address - Fax:702-839-0149
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-20
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV11397207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty