NPIMap

Organization Active NPI

Tristar Surgical Services, LLC

  • Surgical Assistant
  • Cookeville, TN
National Provider Identifier
1053708909
Registry record updated Sep 6, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Surgical AssistantTaxonomy code 246ZC0007X
License
238000411 Issued in IL
Legal business name
TRISTAR SURGICAL SERVICES, LLC
Practice address
5300 Cherry Creek Rd
Cookeville, TN 38506-7007
Phone
(847) 494-1940
NPI assigned
Apr 17, 2015
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Sep 6, 2023

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Mr. Paul Daniel Ptak, SA-C, RSANPI 1730500760
Title
President
Phone
(847) 494-1940

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Surgical AssistantGroup: 193400000X SINGLE SPECIALTY GROUP 246ZC0007X 238000411 IL Primary

Addresses

Primary practice location

5300 Cherry Creek Rd
Cookeville, TN 38506-7007

Mailing address

5300 Cherry Creek Rd
Cookeville, TN 38506-7007
Phone (847) 494-1940

National Provider Directory

National Provider Directory

Practitioners & affiliated clinicians

Practitioners 2

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1429228800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1693958400000",
    "number": "1053708909",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5300 CHERRY CREEK RD",
            "city": "COOKEVILLE",
            "state": "TN",
            "postal_code": "385067007",
            "telephone_number": "847-494-1940"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5300 CHERRY CREEK RD",
            "city": "COOKEVILLE",
            "state": "TN",
            "postal_code": "385067007",
            "telephone_number": "847-494-1940"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "TRISTAR SURGICAL SERVICES, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2015-04-17",
        "last_updated": "2023-09-06",
        "certification_date": "2022-10-27",
        "status": "A",
        "authorized_official_last_name": "PTAK",
        "authorized_official_first_name": "PAUL",
        "authorized_official_middle_name": "DANIEL",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "847-494-1940",
        "authorized_official_name_prefix": "Mr.",
        "authorized_official_credential": "SA-C, RSA"
    },
    "taxonomies": [
        {
            "code": "246ZC0007X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Specialist/Technologist, Other, Surgical Assistant",
            "state": "IL",
            "license": "238000411",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Cookeville, TN

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 6, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.