Provider Demographics
NPI:1740343623
Name:TRI-STARS INC
Entity type:Organization
Organization Name:TRI-STARS INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BILLING AGENT
Authorized Official - Prefix:
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:
Authorized Official - Last Name:MANSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:906-786-2051
Mailing Address - Street 1:828 SHERIDAN RD
Mailing Address - Street 2:
Mailing Address - City:ESCANABA
Mailing Address - State:MI
Mailing Address - Zip Code:49829-1531
Mailing Address - Country:US
Mailing Address - Phone:906-786-2051
Mailing Address - Fax:
Practice Address - Street 1:9425 00.25 RD
Practice Address - Street 2:
Practice Address - City:COOKS
Practice Address - State:MI
Practice Address - Zip Code:49817-9607
Practice Address - Country:US
Practice Address - Phone:906-644-2488
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-19
Last Update Date:2008-06-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI2110013416L0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3416L0300XTransportation ServicesAmbulanceLand Transport
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI4365547Medicaid
MI4365547Medicaid
MI4365547Medicaid