Healthcare Provider Details

I. General information

NPI: 1366479644
Provider Name (Legal Business Name): TRI-STAR ANESTHESIA P.L.L.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/26/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

310 25TH AVE N SUITE 105
NASHVILLE TN
37203-1515
US

IV. Provider business mailing address

PO BOX 16068
HIGH POINT NC
27261-6068
US

V. Phone/Fax

Practice location:
  • Phone: 615-329-9023
  • Fax:
Mailing address:
  • Phone: 336-882-4615
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WP0000X
TaxonomyPain Management Registered Nurse
License Number
License Number State

VIII. Authorized Official

Name: MR. VICTOR L MARTIN
Title or Position: MANAGING PARTNER
Credential: CRNA
Phone: 615-329-9023