Provider Demographics
NPI:1265190383
Name:TRISTAN NORTH ATTLEBORO PC
Entity type:Organization
Organization Name:TRISTAN NORTH ATTLEBORO PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:RYAN
Authorized Official - Middle Name:J
Authorized Official - Last Name:WELTER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:508-316-0725
Mailing Address - Street 1:465 S WASHINGTON ST
Mailing Address - Street 2:
Mailing Address - City:NORTH ATTLEBORO
Mailing Address - State:MA
Mailing Address - Zip Code:02760-2159
Mailing Address - Country:US
Mailing Address - Phone:508-316-0725
Mailing Address - Fax:508-316-3060
Practice Address - Street 1:465 S WASHINGTON ST
Practice Address - Street 2:
Practice Address - City:NORTH ATTLEBORO
Practice Address - State:MA
Practice Address - Zip Code:02760-2159
Practice Address - Country:US
Practice Address - Phone:508-316-0725
Practice Address - Fax:508-316-3060
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:SMW MANAGEMENT LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2021-12-06
Last Update Date:2021-12-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QU0200XAmbulatory Health Care FacilitiesClinic/CenterUrgent Care