Provider Demographics
NPI:1114500477
Name:TWIN STATES INFUSION CLINICS, LLC
Entity Type:Organization
Organization Name:TWIN STATES INFUSION CLINICS, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGING MEMBER
Authorized Official - Prefix:
Authorized Official - First Name:LOGAN
Authorized Official - Middle Name:
Authorized Official - Last Name:DAVIS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:601-482-7420
Mailing Address - Street 1:2908 S LAMAR BLVD
Mailing Address - Street 2:
Mailing Address - City:OXFORD
Mailing Address - State:MS
Mailing Address - Zip Code:38655-5354
Mailing Address - Country:US
Mailing Address - Phone:662-260-3366
Mailing Address - Fax:662-269-1568
Practice Address - Street 1:2908 S LAMAR BLVD
Practice Address - Street 2:
Practice Address - City:OXFORD
Practice Address - State:MS
Practice Address - Zip Code:38655-5354
Practice Address - Country:US
Practice Address - Phone:662-260-3366
Practice Address - Fax:662-269-1568
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-05-04
Last Update Date:2022-11-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QI0500XAmbulatory Health Care FacilitiesClinic/CenterInfusion Therapy