MEDICARE: TRI-STAR PEDIATRICS SERVICES CO

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	208000000X	Pediatrics Physician	10073	NV

General Provider Information

NPI Number	:	1346597903
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	TRI-STAR PEDIATRICS SERVICES CO

Provider Business Mailing Address
First Line	:	2510 WIGWAM PKWY
Second Line	:	SUITE 103
City	:	HENDERSON
State	:	NV
Zip	:	89074-7115
Country	:	US
Telephone Number	:	702-558-3551
Fax Number	:	702-361-0983

Provider Business Practice Location Address
First Line	:	2510 WIGWAM PKWY
Second Line	:	SUITE 103
City	:	HENDERSON
State	:	NV
Zip	:	89074-7115
Country	:	US
Telephone Number	:	702-558-3551
Fax Number	:	702-361-0983

Authorized Official
Title or Position	:	OFFICE MANAGER
Name	:	MR. FIL QUIMBO ALMENARIO
Credential	:
Telephone Number	:	702-558-3551

Provider Enumeration Date	:	08/13/2012
Last Update Date	:	08/13/2012

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