MEDICARE: TRI TE

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	207R00000X	Internal Medicine Physician	Q4311	TX
2	207RC0000X	Cardiovascular Disease Physician	Q4311	TX
3	207RI0011X	Interventional Cardiology Physician	DO3771	NV

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	DO3771	OTHER	NV	STATE LICENSE
2	445253YLUJ	OTHER		WELLMED MEDICAL GROUP
3	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1447632971
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	TRI TE

Provider Business Mailing Address
First Line	:	6355 S BUFFALO DR FL 3
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89113-2133
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	8205 W WARM SPRINGS RD # R210
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89113-3645
Country	:	US
Telephone Number	:	702-534-5464
Fax Number	:	702-534-5465

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/20/2015
Last Update Date	:	11/19/2024

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Directions to “ TRI TE ” Practice Location

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