Provider Demographics
NPI:1285903526
Name:TRI STATE WOMENS SERVICES LLC
Entity type:Organization
Organization Name:TRI STATE WOMENS SERVICES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:VICE PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:STEPHEN
Authorized Official - Middle Name:L
Authorized Official - Last Name:PAGE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:615-844-9849
Mailing Address - Street 1:50 AMENIA RD
Mailing Address - Street 2:P.O. BOX 1040
Mailing Address - City:SHARON
Mailing Address - State:CT
Mailing Address - Zip Code:06069-2268
Mailing Address - Country:US
Mailing Address - Phone:860-364-0536
Mailing Address - Fax:860-364-1299
Practice Address - Street 1:50 AMENIA RD
Practice Address - Street 2:
Practice Address - City:SHARON
Practice Address - State:CT
Practice Address - Zip Code:06069-2268
Practice Address - Country:US
Practice Address - Phone:860-364-0536
Practice Address - Fax:860-364-1299
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-12-15
Last Update Date:2014-06-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CTD100070627Medicare PIN