Healthcare Provider Details

I. General information

NPI: 1811692114
Provider Name (Legal Business Name): TRISTATE INFUSION CLINIC, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/04/2023
Last Update Date: 04/04/2023
Certification Date: 04/04/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1900 S WALTON BLVD STE 3
BENTONVILLE AR
72712-6755
US

IV. Provider business mailing address

1900 S WALTON BLVD STE 3
BENTONVILLE AR
72712-6755
US

V. Phone/Fax

Practice location:
  • Phone: 479-250-9555
  • Fax: 866-220-3710
Mailing address:
  • Phone: 479-250-9555
  • Fax: 866-220-3710

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QI0500X
TaxonomyInfusion Therapy Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: PATRICK MCFERRIN
Title or Position: OWNER
Credential:
Phone: 479-250-9555