Healthcare Provider Details

I. General information

NPI: 1124789573
Provider Name (Legal Business Name): TRISTATE INFUSION, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/07/2022
Last Update Date: 07/10/2025
Certification Date: 07/10/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1211 SE 28TH ST STE 10
BENTONVILLE AR
72712-3886
US

IV. Provider business mailing address

1211 SE 28TH ST STE 10
BENTONVILLE AR
72712-3886
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 TaxonomyN
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code332BP3500X
TaxonomyParenteral & Enteral Nutrition Supplies (DME)
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code333600000X
TaxonomyPharmacy
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code3336H0001X
TaxonomyHome Infusion Therapy Pharmacy
License Number
License Number State
# 5
Primary TaxonomyY
Taxonomy Code251F00000X
TaxonomyHome Infusion Agency
License Number
License Number State

VIII. Authorized Official

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