MEDICARE: TRI-STAR ASE, INC.

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	332B00000X	Durable Medical Equipment & Medical Supplies

General Provider Information

NPI Number	:	1750518098
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	TRI-STAR ASE, INC.

Provider Business Mailing Address
First Line	:	27281 LAS RAMBLAS
Second Line	:	#200
City	:	MISSION VIEJO
State	:	CA
Zip	:	92691-6324
Country	:	US
Telephone Number	:	949-290-6488
Fax Number	:	949-266-0372

Provider Business Practice Location Address
First Line	:	27281 LAS RAMBLAS
Second Line	:	#200
City	:	MISSION VIEJO
State	:	CA
Zip	:	92691-6324
Country	:	US
Telephone Number	:	949-290-6488
Fax Number	:	949-266-0372

Authorized Official
Title or Position	:	PRESIDENT
Name	:	MRS. ELLEN JANE SHANAHAN
Credential	:
Telephone Number	:	949-290-6488

Provider Enumeration Date	:	06/13/2009
Last Update Date	:	06/13/2009

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