Provider Demographics
NPI:1457530388
Name:TRISTATE HEALTHCARE RESOURCES, LLC
Entity Type:Organization
Organization Name:TRISTATE HEALTHCARE RESOURCES, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:BRIAN
Authorized Official - Middle Name:
Authorized Official - Last Name:HURST
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:740-574-8961
Mailing Address - Street 1:11826 GALLIA PIKE
Mailing Address - Street 2:SUITE D
Mailing Address - City:WHEELERSBURG
Mailing Address - State:OH
Mailing Address - Zip Code:45694-9119
Mailing Address - Country:US
Mailing Address - Phone:740-574-8961
Mailing Address - Fax:740-874-1600
Practice Address - Street 1:11826 GALLIA PIKE
Practice Address - Street 2:SUITE D
Practice Address - City:WHEELERSBURG
Practice Address - State:OH
Practice Address - Zip Code:45694-9119
Practice Address - Country:US
Practice Address - Phone:740-574-8961
Practice Address - Fax:740-874-1600
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-10-27
Last Update Date:2007-10-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty