Provider Demographics
NPI:1003655903
Name:TRISTATE INFUSION CLINICS, LLC
Entity type:Organization
Organization Name:TRISTATE INFUSION CLINICS, LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:PATRICK
Authorized Official - Middle Name:RYAN
Authorized Official - Last Name:MCFERRIN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:662-260-3366
Mailing Address - Street 1:9140 HIGHWAY 51 N STE C
Mailing Address - Street 2:
Mailing Address - City:SOUTHAVEN
Mailing Address - State:MS
Mailing Address - Zip Code:38671-1233
Mailing Address - Country:US
Mailing Address - Phone:662-260-3366
Mailing Address - Fax:662-269-1568
Practice Address - Street 1:9140 HIGHWAY 51 N STE C
Practice Address - Street 2:
Practice Address - City:SOUTHAVEN
Practice Address - State:MS
Practice Address - Zip Code:38671-1233
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:2024-05-21
Last Update Date:2024-11-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QI0500XAmbulatory Health Care FacilitiesClinic/CenterInfusion Therapy