Provider Demographics
NPI:1053708909
Name:TRISTAR SURGICAL SERVICES, LLC
Entity type:Organization
Organization Name:TRISTAR SURGICAL SERVICES, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:PAUL
Authorized Official - Middle Name:DANIEL
Authorized Official - Last Name:PTAK
Authorized Official - Suffix:
Authorized Official - Credentials:SA-C, RSA
Authorized Official - Phone:847-494-1940
Mailing Address - Street 1:5300 CHERRY CREEK RD
Mailing Address - Street 2:
Mailing Address - City:COOKEVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:38506-7007
Mailing Address - Country:US
Mailing Address - Phone:847-494-1940
Mailing Address - Fax:
Practice Address - Street 1:5300 CHERRY CREEK RD
Practice Address - Street 2:
Practice Address - City:COOKEVILLE
Practice Address - State:TN
Practice Address - Zip Code:38506-7007
Practice Address - Country:US
Practice Address - Phone:847-494-1940
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-04-17
Last Update Date:2023-09-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL238000411246ZC0007X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes246ZC0007XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist, OtherSurgical AssistantGroup - Single Specialty