Provider Demographics
NPI:1124789573
Name:TRISTATE INFUSION, LLC
Entity type:Organization
Organization Name:TRISTATE INFUSION, LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:RYAN
Authorized Official - Middle Name:
Authorized Official - Last Name:MCFERRIN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:479-250-9555
Mailing Address - Street 1:1211 SE 28TH ST STE 10
Mailing Address - Street 2:
Mailing Address - City:BENTONVILLE
Mailing Address - State:AR
Mailing Address - Zip Code:72712-3886
Mailing Address - Country:US
Mailing Address - Phone:479-250-9555
Mailing Address - Fax:866-220-3710
Practice Address - Street 1:1211 SE 28TH ST STE 10
Practice Address - Street 2:
Practice Address - City:BENTONVILLE
Practice Address - State:AR
Practice Address - Zip Code:72712-3886
Practice Address - Country:US
Practice Address - Phone:479-250-9555
Practice Address - Fax:866-220-3710
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-01-07
Last Update Date:2022-01-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336H0001XSuppliersPharmacyHome Infusion Therapy Pharmacy
No332B00000XSuppliersDurable Medical Equipment & Medical Supplies
No332BP3500XSuppliersDurable Medical Equipment & Medical SuppliesParenteral & Enteral Nutrition
No333600000XSuppliersPharmacy