Healthcare Provider Details

I. General information

NPI: 1225832629
Provider Name (Legal Business Name): TRISTATE INFUSION, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/03/2025
Last Update Date: 04/03/2025
Certification Date: 04/03/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1680 CENTURY CENTER PKWY STE 10
MEMPHIS TN
38134-8827
US

IV. Provider business mailing address

1680 CENTURY CENTER PKWY STE 10
MEMPHIS TN
38134-8827
US

V. Phone/Fax

Practice location:
  • Phone: 901-322-8380
  • Fax: 901-328-5664
Mailing address:
  • Phone: 901-322-8380
  • Fax: 901-328-5664

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number
License Number State

VIII. Authorized Official

Name: LOGAN E DAVIS
Title or Position: OWNER
Credential:
Phone: 601-482-7420