Provider Demographics
NPI:1104817089
Name:TRI-STAR MEDICAL TRANSPORT, INC.
Entity type:Organization
Organization Name:TRI-STAR MEDICAL TRANSPORT, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:LAURA
Authorized Official - Middle Name:
Authorized Official - Last Name:KUHR
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:919-878-1661
Mailing Address - Street 1:2820 TRAWICK RD
Mailing Address - Street 2:
Mailing Address - City:RALEIGH
Mailing Address - State:NC
Mailing Address - Zip Code:27604-3757
Mailing Address - Country:US
Mailing Address - Phone:919-878-1661
Mailing Address - Fax:919-878-0415
Practice Address - Street 1:2820 TRAWICK RD
Practice Address - Street 2:
Practice Address - City:RALEIGH
Practice Address - State:NC
Practice Address - Zip Code:27604-3757
Practice Address - Country:US
Practice Address - Phone:919-878-1661
Practice Address - Fax:919-878-0415
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-10-31
Last Update Date:2011-02-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC15503416L0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3416L0300XTransportation ServicesAmbulanceLand Transport
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC590014169OtherRAILROAD MEDICARE
NC0728KOtherBCBS
NC3406774Medicaid
NC2783019Medicare ID - Type Unspecified