Provider Demographics
NPI:1942551833
Name:TRISTATE HEALTH PARTNERS INC.
Entity Type:Organization
Organization Name:TRISTATE HEALTH PARTNERS INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:SHELLY
Authorized Official - Middle Name:
Authorized Official - Last Name:GRANT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:240-313-9949
Mailing Address - Street 1:10715 DOWNSVILLE PIKE
Mailing Address - Street 2:SUITE 103
Mailing Address - City:HAGERSTOWN
Mailing Address - State:MD
Mailing Address - Zip Code:21740-7240
Mailing Address - Country:US
Mailing Address - Phone:240-313-9940
Mailing Address - Fax:240-313-9941
Practice Address - Street 1:10715 DOWNSVILLE PIKE
Practice Address - Street 2:SUITE 103
Practice Address - City:HAGERSTOWN
Practice Address - State:MD
Practice Address - Zip Code:21740-7240
Practice Address - Country:US
Practice Address - Phone:240-313-9940
Practice Address - Fax:240-313-9941
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-10-02
Last Update Date:2012-10-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes302F00000XManaged Care OrganizationsExclusive Provider Organization