Provider Demographics
NPI:1942342373
Name:TRISTAR MEDICAL SERVICES, LLC
Entity Type:Organization
Organization Name:TRISTAR MEDICAL SERVICES, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEMBER
Authorized Official - Prefix:MRS
Authorized Official - First Name:SONJA
Authorized Official - Middle Name:
Authorized Official - Last Name:WILLIAMS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:937-429-3188
Mailing Address - Street 1:3185 WATERHOUSE DR
Mailing Address - Street 2:
Mailing Address - City:BEAVERCREEK
Mailing Address - State:OH
Mailing Address - Zip Code:45432-2626
Mailing Address - Country:US
Mailing Address - Phone:937-429-3188
Mailing Address - Fax:937-429-3144
Practice Address - Street 1:3185 WATERHOUSE DR
Practice Address - Street 2:
Practice Address - City:BEAVERCREEK
Practice Address - State:OH
Practice Address - Zip Code:45432-2626
Practice Address - Country:US
Practice Address - Phone:937-429-3188
Practice Address - Fax:937-429-3144
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-13
Last Update Date:2018-08-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH1608156332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2640646Medicaid
OH2640646Medicaid