Provider Demographics
NPI:1821548280
Name:TRISTAR MEDICAL GROUP - LEGACY HEALTH, LLC
Entity Type:Organization
Organization Name:TRISTAR MEDICAL GROUP - LEGACY HEALTH, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:AUTHORIZED OFFICIAL
Authorized Official - Prefix:
Authorized Official - First Name:DAN
Authorized Official - Middle Name:
Authorized Official - Last Name:SYKES
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:615-342-6878
Mailing Address - Street 1:2400 PATTERSON STREET, SUITE 418
Mailing Address - Street 2:
Mailing Address - City:NASHVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37203-1575
Mailing Address - Country:US
Mailing Address - Phone:615-342-6000
Mailing Address - Fax:
Practice Address - Street 1:2400 PATTERSON STREET, SUITE 418
Practice Address - Street 2:
Practice Address - City:NASHVILLE
Practice Address - State:TN
Practice Address - Zip Code:37203-1575
Practice Address - Country:US
Practice Address - Phone:615-342-6000
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-10-10
Last Update Date:2016-10-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty