Provider Demographics
NPI:1750518098
Name:TRI-STAR ASE, INC.
Entity type:Organization
Organization Name:TRI-STAR ASE, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MRS
Authorized Official - First Name:ELLEN
Authorized Official - Middle Name:JANE
Authorized Official - Last Name:SHANAHAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:949-290-6488
Mailing Address - Street 1:27281 LAS RAMBLAS
Mailing Address - Street 2:#200
Mailing Address - City:MISSION VIEJO
Mailing Address - State:CA
Mailing Address - Zip Code:92691-6324
Mailing Address - Country:US
Mailing Address - Phone:949-290-6488
Mailing Address - Fax:949-266-0372
Practice Address - Street 1:27281 LAS RAMBLAS
Practice Address - Street 2:#200
Practice Address - City:MISSION VIEJO
Practice Address - State:CA
Practice Address - Zip Code:92691-6324
Practice Address - Country:US
Practice Address - Phone:949-290-6488
Practice Address - Fax:949-266-0372
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-06-13
Last Update Date:2009-06-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies